GRAY's Atlas of Anatomy

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GRAY’S 

ATLAS 

OF ANATOMY 

tahir99 - VRG 

& 

vip.persianss.ir 

SECOND EDITION 


Richard L. Drake, PhD, FAAA 

Director of Anatomy 

Professor of Surgery 

Cleveland Clinic Lerner College of Medicine 

Case Western Reserve University 

Cleveland, Ohio, USA 

A. Wayne Vogl, PhD, FAAA 

Professor of Anatomy and Cell Biology 

Department of Cellular and Physiological Sciences 

Faculty of Medicine 

University of British Columbia 

Vancouver, British Columbia, Canada 

Adam W. M. Mitchell, MBBS, FRCS, FRCR 

Consultant Radiologist and Senior Lecturer Imperial College 

Chelsea and Westminster Hospital 

London, UK 

Illustrated by 

Richard M. Tibbitts 

Saffron Walden, UK 

Paul E. Richardson 

Cambridge, UK 

Photographs by 

Ansell Horn 

tahir99 - VRG 

& 



GRAY’S 

ATLAS 

OF ANATOMY 

tahir99 - VRG 

& 


SECOND EDITION 

Richard L. Drake A. Wayne Vogl Adam W. M. Mitchell 


Paul E. Richardson 


1600 John F. Kennedy Blvd. 

Ste 1800 

Philadelphia, PA 19103-2899 

GRAY’S ATLAS OF ANATOMY, SECOND EDITION ISBN: 978-1-4557-4802-0 

INTERNATIONAL EDITION ISBN: 978-0-7020-5237-8 

Copyright © 2015, 2008 by Churchill Livingstone, an imprint of Elsevier Inc. 

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any 

means, electronic or mechanical, including photocopying, recording, or any information storage and 

retrieval system, without permission in writing from the publisher. Details on how to seek permission, 

further information about the Publisher’s permissions policies and our arrangements with organizations 

such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: 

www.elsevier.com/permissions. 

Notices 

Knowledge and best practice in this field are constantly changing. As new research and experience 

broaden our understanding, changes in research methods, professional practices, or medical treatment 

may become necessary. 

Practitioners and researchers must always rely on their own experience and knowledge in evaluating 

and using any information, methods, compounds, or experiments described herein. In using such 

information or methods they should be mindful of their own safety and the safety of others, including 

parties for whom they have a professional responsibility. 

With respect to any drug or pharmaceutical products identified, readers are advised to check the 

most current information provided (i) on procedures featured or (ii) by the manufacturer of each 

product to be administered, to verify the recommended dose or formula, the method and duration 

of administration, and contraindications. It is the responsibility of practitioners, relying on their own 

experience and knowledge of their patients, to make diagnoses, to determine dosages and the best 

treatment for each individual patient, and to take all appropriate safety precautions. 

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume 

any liability for any injury and/or damage to persons or property as a matter of products liability, 

negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas 

contained in the material herein. 

The Publisher 

ISBN: 978-1-4557-4802-0 

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VP Global Medical Education Content: Madelene Hyde 

Senior Manager, Content Development: Rebecca Gruliow 

Publishing Services Manager: Patricia Tannian 

Senior Project Manager: John Casey 

Design and Art Direction: Antbits Ltd. 

Printed in Canada 

Last digit is the print number: 9 8 7 6 5 4 3 2 1 

Working together to grow 

libraries in developing countries 

www.elsevier.com | www.bookaid.org | www.sabre.org 


To my wife who supports me and to my parents who are always with me. 

Richard L. Drake 

To my family, to my professional colleagues and role models, and to 

my students. 

Wayne Vogl 

Thanks, to Cathy, Max and Elsa 

Adam W. M. Mitchell 

To my family – my inspiration, Evi, Zoë, and Nicholas x 


To Lesley and in memory of AMR and JER 

Paul Richardson 


ACKNOWLEDGMENTS 

The following reviewers helped enormously with their detailed critiques and suggestions 

for every chapter. Their assistance was invaluable. 

Mark Hankin, PhD, University of Toledo College of Medicine, Toledo, Ohio 

Marios Loukas, MD, PhD, St. George’s University School of Medicine, Grenada 

James J. Rechtien, DO, PhD, Michigan State University School of Medicine, East Lansing, 

Michigan 

William A. Roy, PT, PhD, Touro University, Henderson, Nevada 

Susan Standring, PhD, DSc, Professor of Experimental Neurobiology and Head, Division 

of Anatomy, Cell and Human Biology, Guy’s, King’s and St Thomas’ School of Biomedical 

Sciences, King’s College London, London 

William Swartz, PhD, Louisiana State University Health Sciences Center, Baton Rouge, 

Louisiana 

Mark F. Teaford, PhD, Johns Hopkins University School of Medicine, Baltimore, Maryland 

We want to thank Dr. Bruce Crawford for a radiograph of the head and neck and Dr. 

Murray Morrison for laryngoscopic images of the larynx; Dr. Jerry Healy for three images in 

the Abdomen section: the celiac artery, the bile duct system, and a three-dimensional view 

of abdominal vessels; and Siemens Medical Solutions USA and the following individuals with 

that company: Mollie Beaver, Director, CT Clinical Solutions, and Dr. Louise McKenna, Global 

Clinical Marketing Manager, CT Oncology, who supplied a syngo Multi-modality Workplace, 

which was used to acquire the majority of the clinical images. 

Stuart Morrison, MD, helped with all aspects of coordinating the collection of the 

radiographic material. Radiological assistance and images were contributed in each of the 

following areas: 

Back 

Thorax 

Abdomen 

Pelvis 

Extremities 

Head and Neck 

Mark Kayanja, MD, PhD 

Jeffrey S. Ross, MD 

Mario Garcia, MD 

A. Michael Lincoff, MD 

Namita Gandhi, MD 

Michelle Inkster, MD, PhD 

Brian R. Lane, MD 

Anand Rao, MD 

James S. Wu, MD 

Matthew Barber, MD, MHS 

Tommaso Falcone, MD 

J. Stephen Jones, MD 

Eunice Moon, MD 

James S. Newman, MD, PhD 

Hakan Ilaslan, MD 

Bradford J. Richmond, MD 

Joshua Polster, MD 

Todd W. Stultz, DDS, MD 

J. Martin Paloma, DDS, MSD 

Cindy McConnaughy 

Ronald Lemmo, DDS 

vi 


FOREWORD 

1 

A working knowledge of anatomy is not an “optional extra” 

for health care professionals – it is fundamental. Acquiring that 

knowledge has always challenged even the most motivated 

students. Over many generations, learning materials that 

aid the process effectively have been warmly welcomed by 

students and their teachers (and by patients, who are the 

ultimate beneficiaries of that knowledge). I remember my 

own students’ response when I first included illustrations 

from Gray’s Anatomy for Students in a lecture—afterward, I 

was asked repeatedly for the source of the marvelous pictures. 

Looking beyond the “wow” factor that leapt from the pages 

of the book, it was clear that an enormous amount of thought 

and skill had gone into producing the artwork. 

This atlas contains a series of additional outstanding 

pieces of anatomical art from the illustrative team of Richard 

Tibbitts and Paul Richardson that will complement those in 

Gray’s Anatomy for Students, combined with relevant clinical 

pictures, surface anatomy, and images from a range of 

modern imaging procedures. Of course, anatomy cannot be 

learned from books and interactive DVDs alone, no matter 

how excellent they may be. Anatomy is a practical subject, 

best learned by gaining hands-on experience of the body. 

Students should spend as much time as they can examining 

cadaveric dissections (if they do not have the opportunity to 

dissect themselves) and should always read from screen or 

page with the appropriate bones in front of them. They need 

to combine and correlate information from a wide variety of 

sources in order to gain the working knowledge mentioned 

earlier. 

This atlas will provide a valuable companion to their studies, 

and I am confident that it will remain in their libraries long 

after they have completed the early stages of their training. 

Susan Standring, PhD, DSc, FKC, Hon FRCS 

Emeritus Professor of Anatomy 

King’s College, London 

vii 


FOREWORD 

We began working on Gray’s Atlas of Anatomy in 2005 

following the publication of our textbook, Gray’s Anatomy for 

Students. We wanted to produce an atlas that would build on 

themes and concepts established in the textbook and that 

would couple artistic renderings of “internal” gross anatomy 

with actual “living” anatomy, as visualized with modern 

imaging techniques and with surface anatomy. We believe 

that the final atlas presents a fresh and integrated approach to 

anatomy that is accessible to entry-level students in anatomy, 

as well as to students at more advanced levels. 

Because an atlas is used in a much different way than a 

textbook, we could not simply repackage figures used in Gray’s 

Anatomy for Students and put them in the atlas. Consequently, 

most of the figures in the atlas are new and were designed 

to present structures in a more complete context than in the 

textbook, even though the color palette and overall look of 

the figures in both the atlas and textbook are similar. Also, 

figures in the atlas provide additional detail not included in 

the textbook and directly correlate artistic representations 

of anatomy with computed tomography (CT) and magnetic 

resonance imaging (MRI). Where appropriate, we have 

included endoscopic, laryngoscopic, and laparoscopic views 

of the anatomy and have included examples of ultrasound 

images. In a number of regions, we also have reconstructed 

the internal anatomy of patients by abstracting specific 

information from multiple MR or CT images, and we present 

these reconstructions together with artwork of the same 

anatomy. Although the artwork was done independently of 

the reconstructed images, the two types of representations 

are strikingly similar. 

Each page of this atlas was planned prior to beginning work 

on the figures, and all of the artwork was generated digitally. 

Most of the figures were created from an extensive digital 

database created for the textbook. Each figure was reviewed 

for accuracy and revised accordingly. 

We hope that the textbook and atlas used together will 

provide new and powerful learning tools for students of 

human gross anatomy. 

The Authors 

viii 


PREFACE 

1 

The 2nd edition of Gray’s Atlas of Anatomy continues in the 

tradition of the 1st edition, coupling artistic rendering with 

actual living anatomy as visualized with modern imaging 

techniques and surface anatomy. The combination of modern 

illustrations, imaging, and surface anatomy is unique among 

atlases available today. 

We have also added additional study aids that should enhance 

the learning experience. At the end of every chapter tables 

and schematic drawings have been added for quick review 

of subject matter. These include major nerves plexuses 

throughout the body, branching patterns of major arteries, 

summaries of muscles organized into compartments or 

regions, and other helpful information. This material is 

designed to provide the reader quick access to information. 

It’s our hope that the 2nd edition of Gray’s Atlas of Anatomy 

will become a valuable learning aid for students encountering 

anatomy for the first time or for the individual seeking to 

review information critical to their daily experiences. 

The Authors 

ix 


This page intentionally left blank 


CONTENTS 1 

1 

Anatomical position, terms, and planes 2 

Anatomical planes and imaging 3 

Surface anatomy: anterior view 4 

Surface anatomy: posterior view 5 

Skeleton: anterior 6 

Skeleton: posterior 7 

Muscles: anterior 8 

Muscles: posterior 9 

Vascular system: arteries 10 

Vascular system: veins 11 

Lymphatic system 12 

Nervous system 13 

Sympathetics 14 

Parasympathetics 15 

Dermatomes 16 

Cutaneous nerves 17 

2 

THE BODY 

BACK 

Surface anatomy 20 

Vertebral column 21 

Regional vertebrae 22 

Cervical vertebrae 23 

Thoracic vertebrae 26 

Lumbar vertebrae 28 

Sacrum 31 

Intervertebral foramina and discs 32 

Intervertebral disc problems 33 

Joints and ligaments 35 

Back musculature: surface anatomy 36 

Superficial musculature 37 

Intermediate musculature 39 

Deep musculature 40 

Back musculature: transverse section 42 

Suboccipital region 43 

Spinal nerves 44 

Spinal cord 45 

Spinal cord vasculature 46 

Venous drainage of spinal cord 47 

Meninges 48 

Spinal cord: imaging 50 

Transverse section: thoracic region 52 

Dermatomes and cutaneous nerves 53 

Tables 54 

3 

THORAX 

Surface anatomy with bones 62 

Bony framework 63 

Ribs 65 

Articulations 66 

Breast 68 

Pectoral region 70 

Thoracic wall muscles 72 

Diaphragm 73 

Arteries of the thoracic wall 74 

Veins of the thoracic wall 75 

Nerves of the thoracic wall 76 

Lymphatics of the thoracic wall 77 

Intercostal nerves and arteries 78 

Pleural cavities and mediastinum 79 

Parietal pleura 80 

Surface projections of pleural recesses 81 

Right lung 82 

Left lung 83 

Lung lobes: surface relationship 84 

Lung lobes: imaging 85 

Bronchial tree 86 

Bronchopulmonary segments 87 

Pulmonary vessels and plexus 88 

Pulmonary vessels: imaging 89 

Mediastinum 91 

Pericardium 92 

Pericardial layers 93 

Anterior surface of heart 94 

Base and diaphragmatic surface of heart 95 

Right atrium 96 

Right ventricle 97 

Left atrium 98 

Left ventricle 99 

xi 


CONTENTS 

Aortic valve and cardiac skeleton 100 

Cardiac chambers and heart valves 101 

Coronary vessels 102 

Coronary arteries and variations 103 

Cardiac conduction system 105 

Auscultation points and heart sounds 106 

Cardiac innervation 107 

Superior mediastinum: thymus 108 

Superior mediastinum: veins and arteries 109 

Superior mediastinum: arteries and nerves 110 

Superior mediastinum: imaging 111 

Superior mediastinum: veins and trachea 112 

Mediastinum: imaging 113 

Mediastinum: view from right 114 

Mediastinum: imaging – view from right 115 

Mediastinum: view from left 116 

Mediastinum: imaging – view from left 117 

Posterior mediastinum 118 


Transverse section: TVIII level 124 


Visceral efferent (motor) innervation of the heart 126 

Visceral afferents 127 

Tables 128 

4 

ABDOMEN 


Quadrants and regions 135 

Abdominal wall 136 

Muscles 138 

Muscles: rectus sheath 141 

Vessels of the abdominal wall 142 

Arteries and lymphatics of the abdominal wall 143 

Nerves of the abdominal wall 144 


Inguinal region 146 

Inguinal canal 148 

Inguinal hernias 150 

Anterior abdominal wall 151 

Greater omentum 152 

Abdominal viscera 153 

Peritoneal cavity 154 

Abdominal sagittal section 155 

Abdominal coronal section 156 

Arterial supply of viscera 157 

Stomach 158 

Spleen 159 

Arteries of stomach and spleen 160 

Duodenum 162 

Small intestine 164 

Large intestine 166 

Ileocecal junction 168 

Gastrointestinal tract: imaging 169 

Mesenteric arteries 170 

Liver 172 

Vessels of the liver 174 

Segments of the liver 175 

Pancreas and gallbladder 176 

Vasculature of pancreas and duodenum 179 

Venous drainage of viscera 180 

Portosystemic anastomoses 182 

Posterior wall 183 

Vessels of the posterior wall 184 

Diaphragm 185 

Kidneys 186 

Gross structure of kidneys 188 

Kidneys: imaging 189 

Renal vasculature 190 

Branches of the abdominal aorta 192 

Inferior vena cava 193 

Abdominal aorta and inferior vena cava: imaging 194 

Lumbar plexus 196 

Lumbar plexus: cutaneous distribution 197 

Lymphatics 198 

Abdominal innervation 199 

Splanchnic nerves 200 

Visceral efferent (motor) innervation diagram 201 

Visceral afferent (sensory) innervation and 

referred pain diagram 202 

Kidney and ureter visceral afferent 

(sensory) diagram 204 

Tables 206 

xii 


CONTENTS 1 

5 

PELVIS AND PERINEUM 

Surface anatomy and articulated pelvis in men 212 

Surface anatomy and articulated pelvis in women 214 

Pelvic girdle 216 

Pelvic girdle: imaging 217 

Lumbosacral joint 218 

Sacro-iliac joint 219 

Pelvic inlet and outlet 220 

Orientation of pelvic girdle and pelvic brim 221 

Pelvic viscera and perineum in men 222 

Pelvic viscera and perineum in men: imaging 223 

Pelvic viscera and perineum in women 224 

Pelvic viscera and perineum in women: imaging 225 

Lateral wall of pelvic cavity 226 

Floor of pelvic cavity: pelvic diaphragm 227 

Rectum and bladder in situ 230 

Rectum 231 

Bladder in men 232 

Bladder in women 233 

Reproductive system in men 234 

Prostate 235 

Prostate and seminal vesicles 237 

Scrotum 238 

Testes 239 

Penis 240 

Reproductive system in women 241 

Uterus and ovaries 242 

Uterus 243 

Uterus: imaging 244 

Pelvic fascia 245 

Arterial supply of pelvis 246 

Venous drainage of pelvis 247 

Vasculature of the pelvic viscera 248 

Vasculature of uterus 249 

Venous drainage of prostate and penis 250 

Venous drainage of rectum 251 

Sacral and coccygeal nerve plexuses 252 

Pelvic nerve plexus 253 

Hypogastric plexus 254 

Surface anatomy of the perineum 255 

Borders and ceiling of the perineum 258 

Deep pouch and perineal membrane 259 

Muscles and erectile tissues in men 260 

Erectile tissue in men: imaging 261 

Muscles and erectile tissues in women 262 

Erectile tissue in women: imaging 263 

Internal pudendal artery and vein 264 

Pudendal nerve 265 

Vasculature of perineum 266 

Nerves of perineum 267 

Lymphatics of pelvis and perineum in men 268 

Lymphatics of pelvis and perineum in women 269 


Dermatomes 271 

Innervation of reproductive system in men 272 

Innervation of reproductive system in women 273 

Innervation of bladder 274 

Pelvic cavity imaging in men 275 

Pelvic cavity imaging in women 278 

Tables 284 

6 

LOWER LIMB 


Bones of the lower limb 293 

Pelvic bones and sacrum 294 

Articulated pelvis 295 

Proximal femur 296 

Hip joint 297 

Hip joint: structure and arterial supply 299 

Gluteal region: attachments and superficial 

musculature 300 

Gluteal region: superficial and deep muscles 301 

Gluteal region: arteries and nerves 302 

Distal femur and proximal tibia and fibula 304 

Thigh: muscle attachments 305 

Thigh: anterior superficial musculature 306 

Thigh: posterior superficial musculature 307 

Thigh: anterior compartment muscles 308 

Thigh: medial compartment muscles 309 

Femoral triangle 310 

xiii

CONTENTS 

Anterior thigh: arteries and nerves 311 

Anterior thigh: arteries 312 

Thigh: posterior compartment muscles 313 

Posterior thigh: arteries and nerves 314 

Transverse sections: thigh 316 

Knee joint 318 

Ligaments of the knee 320 

Menisci and cruciate ligaments 322 

Knee: bursa and capsule 326 

Knee surface: muscles, capsule, and arteries 327 

Popliteal fossa 328 

Tibia and fibula 329 

Bones of the foot 330 

Bones and joints of the foot 333 

Talus and calcaneus 334 

Ankle joint 335 

Ligaments of the ankle joint 336 

Leg: muscle attachments 339 

Posterior leg: superficial muscles 340 

Posterior compartment: deep muscles 341 

Posterior leg: arteries and nerves 342 

Lateral compartment: muscles 343 

Anterior leg: superficial muscles 344 

Anterior compartment: muscles 345 

Anterior leg: arteries and nerves 346 

Leg: cutaneous nerves 347 

Transverse sections: leg 348 

Foot: muscle attachments 350 

Foot: ligaments 351 

Dorsum of foot 353 

Dorsum of foot: arteries and nerves 354 

Plantar aponeurosis 356 

Plantar region (sole) musculature: first layer 357 

Plantar region (sole) musculature: second layer 358 

Plantar region (sole) musculature: third layer 359 

Plantar region (sole) musculature: fourth layer 360 

Plantar region (sole): arteries and nerves 361 

Dorsal hood and tarsal tunnel 363 

Superficial veins of the lower limb 364 

Lymphatics of the lower limb 365 

Anterior cutaneous nerves and dermatomes of 

the lower limb 366 

xiv 

Posterior cutaneous nerves and dermatomes of 


Tables 368 

7 

UPPER LIMB 


Bones of the upper limb 385 

Bony framework of shoulder 386 

Scapula 387 

Clavicle: joints and ligaments 388 

Proximal humerus 389 

Glenohumeral joint 390 

Muscle attachments 392 


Deep pectoral region 395 

Walls of the axilla 396 

The four rotator cuff muscles 398 

Deep vessels and nerves of the shoulder 400 

Axillary artery 401 

Brachial artery 402 

Brachial plexus 403 

Medial and lateral cords 404 

Posterior cord 405 

Distal end of humerus and proximal end 

of radius and ulna 406 



Anterior compartment: arteries and nerves 410 

Veins of the arm 411 

Posterior compartment: muscles 412 

Posterior compartment: arteries and nerves 414 

Lymphatics of the arm 415 

Transverse sections: arm 416 

Anterior cutaneous nerves of the arm 418 

Posterior cutaneous nerves of the arm 419 

Elbow joint 420 

Elbow joint: capsule and ligaments 422 

Cubital fossa 424 

Radius and ulna 425 

Bones of the hand and wrist joint 426

CONTENTS 1 

Imaging of the hand and wrist joint 427 

Bones of the hand 428 

Joints and ligaments of the hand 429 

Muscle attachments of forearm 430 

Anterior compartment of forearm: muscles 431 

Anterior compartment of forearm: 

arteries and nerves 434 

Posterior compartment of forearm: muscles 435 

Posterior compartment of forearm: 


Transverse sections: forearm 438 

Carpal tunnel 440 

Muscle attachments of the hand 442 

Superficial palmar region (palm) of hand 443 

Tendon sheaths of hand 444 

Lumbrical muscles 445 

Intrinsic muscles of hand 446 

Palmar region (palm) of hand: arteries and nerves 448 

Arteries of the hand 450 

Innervation of the hand: median and ulnar nerves 451 

Dorsum of hand 452 

Dorsal hoods 453 

Dorsum of hand: arteries 454 

Dorsum of hand: nerves 455 

Anatomical snuffbox 456 

Superficial veins and lymphatics of forearm 457 

Anterior cutaneous nerves of forearm 458 

Posterior cutaneous nerves of upper limb 459 

Tables 460 

8 

HEAD AND NECK 


Bones of the skull 477 

Skull: anterior view 478 

Skull: lateral view 480 

Skull: posterior view 482 

Skull: superior view and roof 483 

Skull: inferior view 484 

Skull: cranial cavity 485 

Ethmoid, lacrimal bone, inferior concha, and vomer 486 

Maxilla and palatine bone 487 

Skull: muscle attachments 488 

Scalp and meninges 490 

Dural partitions 491 

Dural arteries and nerves 492 

Dural venous sinuses 493 

Brain 494 

Brain: imaging 496 

Cranial nerves 498 

Arterial supply to brain 500 

Cutaneous distribution of trigeminal nerve [V] 503 

Facial muscles 504 

Vasculature, facial nerve [VII] and lymphatics 506 

Deep arteries and veins of parotid region 507 

Bony orbit 508 

Section through orbit and structures of eyelid 509 

Eyelids and lacrimal apparatus 510 

Innervation of the lacrimal gland 511 

Muscles of the eyeball 512 

Innervation of the orbit and eyeball 513 

Eye movements 514 

Vasculature of orbit 515 

Eyeball 516 

Eye imaging 517 

Ear surface and sensory innervation 520 

Ear 521 

Middle ear 522 

Internal ear 524 

Ear imaging 525 

Temporal and infratemporal fossae 526 

Bones of the temporal and infratemporal fossae 527 


Temporomandibular joint 530 

Mandibular division of the trigeminal nerve [V] 531 

Parasympathetic innervation 532 

Arteries and veins of temporal and 

infratemporal fossae 533 

Pterygopalatine fossa 534 

Neck surface anatomy 536 

Bones of the neck 537 

Compartments and fascia of the neck 538 

Superficial veins of the neck 539 

xv

CONTENTS 

Muscles of the neck 540 

Nerves in the neck 542 

Cranial nerves in the neck 543 

Cervical plexus and sympathetic trunk 544 

Arteries of the neck 546 

Root of the neck: arteries 548 

Lymphatics of the neck 550 

Pharynx 552 

Muscles of the pharynx 554 

Innervation of the pharynx 556 

Vasculature of the pharynx 557 

Larynx 558 

Laryngeal cavity 560 

Muscles of the larynx 561 

Innervation of the larynx 562 

Thyroid gland 563 

Vasculature of the thyroid gland 564 

Nose and paranasal sinuses 566 

Nasal cavity: bones 567 

Nasal cavity: mucosal linings 568 

Vasculature and innervation of the nasal cavity 569 

Sinus imaging 570 

Oral cavity: bones 572 

Teeth 573 

Teeth: imaging 574 

Anatomy of teeth 575 

Vessels and nerves supplying teeth 576 

Innervation of teeth and gums 577 

Muscles and salivary glands of the oral cavity 578 

Vessels and nerves of the tongue 579 

Tongue 580 

Hard and soft palate 581 

Palate 582 

Innervation of oral cavity 583 


Visceral motor pathways in the head 586 

Tables 588 

INDEX 609 

xvi

1 

CONTENTS 

THE BODY 

Anatomical position, terms, and planes 2 


Surface anatomy: anterior view 4 


Skeleton: anterior 6 


Muscles: anterior 8 


Vascular system: arteries 10 


Lymphatic system 12 


Sympathetics 14 


Dermatomes 16 

Cutaneous nerves 17

THE BODY • Anatomical position, terms, and planes 

Superior 

Sagittal plane 

Coronal plane 

Cranial 

Caudal 

Vertical or 

longitudinal axis 

Medial 

Lateral 

Transverse axis 

Proximal 

Posterior 

Sagittal axis 

Transverse, horizontal, 

or axial plane 

Anterior 

Distal 

Dorsum of hand 

Palmar surface of hand 

Proximal 

Dorsum of foot 

Distal 

Plantar surface of foot 

Inferior 

2


Sacral promontory 

Sacrum 

Small intestine 

Uterus 

Rectum 

Bladder 

Pubic symphysis 

Urethra 

Vagina 

Anal canal 

T2-weighted MR image, in sagittal plane 

Heart 

Liver 

Right colic flexure 

Gallbladder 

Diaphragm 

Left colic flexure 

Stomach 

Transverse colon 


Sigmoid colon 

CT image, with contrast, in coronal plane 

Pectoralis major 

Manubrium of sternum 

Right brachiocephalic vein 

Trachea 

Scapula 

Left brachiocephalic vein 

Brachiocephalic trunk 

Left common carotid artery 

Left subclavian artery 

Esophagus 

CT image, with contrast, in axial plane 

3

THE BODY • Surface anatomy: anterior view 

Sternocleidomastoid 

Clavicle 

Larynx 

Acromion 

Jugular notch 

Clavicle 

Jugular notch 

Pectoralis 

major 

Deltoid 

Deltoid 

Costal 

margin 

Areola 

Xiphoid process 

Xiphoid 

process 

Nipple 

Breast 

Cubital 

fossa 

Cubital fossa 

Umbilicus 

Umbilicus 

Anterior superior 

iliac spine 

Pubic 

symphysis 

Pubic 

symphysis 

Penis 

Scrotum 

Glans penis 

Head of fibula 

Patella 

Tibial tuberosity 

Patella 

Tibia 

Tibia 

Medial malleolus 

Lateral malleolus 


4


Vertebra prominens 

(spinous process 

of CVII) 

Trapezius 


(spinous process 

of CVII) 

Acromion 

Deltoid 

Inferior 

angle of 

scapula 

Olecranon 

Iliac crest 

Spine of scapula 

Latissimus dorsi 

Spinous process 

of TXII 

Deltoid 

Sacral dimple at 

posterior superior 

iliac spine 


of TI 

Medial border 

of scapula 

Iliac crest 

Intergluteal cleft 

Gluteal fold 

Gluteal fold 

Popliteal fossa 

Biceps femoris tendon 



Gastrocnemius 

Calcaneal (Achilles) 

tendon 


Calcaneal tuberosity 


5

THE BODY • Skeleton: anterior 

Frontal bone 

Orbit 


Scapula 

Zygomatic bone 

CVII 

Rib I 

Clavicle 

Maxilla 

Mandible 

Coracoid process 

Acromion 

Lesser tubercle 

Greater tubercle 

Body of sternum 

Humerus 


of sternum 

Trochlea 

Capitulum 

Medial epicondyle 

Lateral epicondyle 

Radius 

Ulna 

Coccyx 

Ilium 

Sacro-iliac joint 

Sacrum 

Pubis 

Carpal bones 

Metacarpals 

Phalanges 

Lesser 

trochanter 

Pubic 

symphysis 

Ischium 

Greater 

trochanter 

Femur 




Patella 

Palpable bone 

(anterior view) 

Fibula 

Tibia 



Tarsal bones 

Metatarsals 

Phalanges 

6


Parietal bone 

Occipital bone 

Mastoid process 

CII (axis) 


Acromion 

External occipital protuberance 

CI (atlas) 

Angle of mandible 

Superior angle of scapula 

Clavicle 


Shoulder joint 

Scapula 


Elbow joint 

Iliac crest 

Posterior superior 

iliac spine 

Sacrum 

Coccyx 

Humerus 


Inferior angle of scapula 

Vertebral column 

Olecranon 

Head of radius 

Radius 

Ulna 

Hip joint 

Greater trochanter 

Wrist joint 

Ischial 

tuberosity 

Ischial spine 

Lesser 

trochanter 

Femur 

Palpable bone 

(posterior view) 



Knee joint 

Medial condyle 

Lateral condyle 

Fibula 

Tibia 


Ankle joint 

Tuberosity of fifth metatarsal 


Calcaneus 

7

THE BODY • Muscles: anterior 

Temporalis 

Orbicularis oculi 

Frontalis 

Masseter 


Trapezius 

Buccinator 

Orbicularis oris 

Scalenes 

Deltoid 


Serratus anterior 

Biceps brachii 

Rectus abdominis 

Pronator teres 

Brachioradialis 

External oblique 

Flexor carpi radialis 

Palmaris longus 

Flexor carpi ulnaris 

Tensor fasciae latae 

Thenar muscles 

Long head of biceps brachii (cut) 

Pectoralis minor 

Short head of biceps brachii (cut) 

Coracobrachialis 

External intercostal 

Internal intercostal 

Brachialis 

Posterior wall of rectus sheath 

Biceps brachii tendon (cut) 

Supinator (superficial head) 

Internal oblique (cut) 

Transversus abdominis 

Flexor digitorum profundus 

Flexor pollicis longus 

Iliopsoas 

Pronator quadratus 

Obturator externus 

Hypothenar muscles 

Adductor brevis 

Sartorius 

Rectus femoris 

Iliotibial tract 

Vastus lateralis 

Vastus medialis 

Pectineus 

Adductor magnus 

Adductor longus 

Gracilis 

Fibularis longus 

Soleus 

Tibialis anterior 

Gastrocnemius 

Extensor digitorum longus 

Extensor hallucis longus 



8


Occipitalis 

Semispinalis capitis 


Trapezius 

Deltoid 

Infraspinatus 


Triceps brachii 


Extensor carpi radialis longus 


Extensor digitorum 

Gluteus maximus 


Long head of biceps femoris 

Semitendinosus 

Semimembranosus 

Gracilis 

Plantaris 

Splenius capitis 

Splenius cervicis 

Rhomboid minor 

Rhomboid major 

Levator scapulae 

Supraspinatus 

Infraspinatus 

Teres minor 

Lateral head of triceps brachii (cut) 

Teres major 

Latissimus dorsi (cut) 

Long head of triceps brachii 


Medial head of triceps brachii 

Erector spinae 

Internal oblique 

Supinator (deep head) 

Gluteus medius 

Abductor pollicis longus 

Extensor pollicis longus 

Extensor pollicis brevis 

Extensor indicis 

Piriformis 

Gemellus superior 

Obturator internus 

Gemellus inferior 

Quadratus femoris 


Short head of biceps femoris 


Long head of biceps femoris (cut) 

Plantaris (cut) 

Popliteus 

Gastrocnemius 

Soleus (cut) 


Soleus 

Flexor digitorum longus 

Flexor hallucis longus 

Calcaneal tendon 

Fibularis brevis (tendon) 

9

THE BODY • Vascular system: arteries 

Superficial temporal artery 

Facial artery 

Vertebral artery 

Right subclavian artery 


Axillary artery 

Internal thoracic artery 

Ascending aorta 

Profunda brachii artery 

Left internal carotid artery 

Left external carotid artery 



Arch of aorta 

Anterior circumflex humeral artery 

Posterior circumflex humeral artery 

Thoracic aorta 

Celiac trunk 

Common hepatic artery 

Brachial artery 

Splenic artery 

Left renal artery 

Radial artery 

Superior mesenteric artery 

Ulnar artery 

Testicular/ovarian artery 

Deep palmar arch 

Inferior mesenteric artery 

Left common iliac artery 

Left internal iliac artery 

Left external iliac artery 

Superficial palmar arch 

Transverse branch of lateral 

circumflex femoral artery 

Descending branch of lateral 


Femoral artery 

Deep artery of thigh 

Popliteal artery 

Anterior tibial artery 

Posterior tibial artery 

Fibular artery 

Dorsalis pedis artery 

10


Superficial temporal vein 

Facial vein 

Anterior jugular vein 

Right subclavian vein 


Axillary vein 

Cephalic vein 

Left external jugular vein 

Left internal jugular vein 

Left subclavian vein 


Superior vena cava 

Azygos vein 

Basilic vein 

Brachial veins 

Hepatic vein 

Inferior vena cava 

Splenic vein 

Portal vein 

Median cubital vein 

Testicular/ovarian vein 

Cephalic vein 

Basilic vein 

Radial vein 

Ulnar vein 

Inferior mesenteric vein 

Superior mesenteric vein 

Left common iliac vein 

Left external iliac vein 

Left internal iliac vein 

Deep vein of thigh 

Femoral vein 

Great saphenous vein 

Popliteal vein 

Small saphenous vein 

Anterior tibial vein 

Posterior tibial vein 

Posterior fibular vein 



Superficial veins 

Deep veins 

Dorsal venous arch 

11

THE BODY • Lymphatic system 

Pharyngeal tonsil 

Submandibular nodes 

Palatine tonsil 

Lingual tonsil 

Thoracic duct 

Cervical lymph nodes 


Right lymphatic duct 


Axillary lymph nodes 

Lymphatic vessels 

of the upper limb 

Thoracic duct 

Cubital nodes 

Cisterna chyli 

Intestinal lymph nodes 

Large intestine 

Appendix 

Iliac lymph nodes 

Thymus gland 

Tracheal lymph nodes 

Spleen 


Lymph nodules in 

small intestine 

(Peyer’s patch) 

Deep lymph nodes 

Trabecula 

Valve 

Efferent lymphatic vessel 

Cortex 

(containing 

lymphocytes and 

macrophages) 

Capsule 

Reticular 

fiber 

Medullary 

sinus 

Lymph 

Afferent lymphatic vessels 

Structure of a lymph node 

Femoral lymph nodes 

Inguinal lymph nodes 

Bone marrow 

Popliteal lymph nodes 

Lymphatic vessels 

of the lower limb 

Drainage of the right 

lymphatic duct 

Drainage of the 

thoracic duct 

Principal components of the lymphatic system 

12


Trigeminal nerve [V] 

Brachial plexus 

Cervical plexus 

Phrenic nerve 

Axillary nerve 

Musculocutaneous nerve 

Radial nerve 

Intercostal nerves 

Median nerve 

Ulnar nerve 

Conus medullaris 

Cauda equina 

Superficial branch of radial nerve 

Deep branch of radial nerve 

Median nerve 

Ulnar nerve 

Lumbar plexus 

Femoral nerve 

Sacral plexus 

Lateral femoral 

cutaneous nerve 

Sciatic nerve 

Lateral femoral cutaneous nerve 

Obturator nerve 

Peripheral nervous 

system (PNS) 

Cranial 

nerves 

Central nervous 

system (CNS) 

Brain 

Tibial nerve 

Posterior cutaneous nerve 

Spinal 

nerves 

Spinal cord 

Saphenous nerve 

Common fibular nerve 

Sural nerve 

Superficial fibular nerve 

Deep fibular nerve 

Tibial nerve 

Sural nerve 

13

THE BODY • Sympathetics 

Peripheral 

Organs 

T1 

Preganglionic sympathetic nerves 

follow somatic nerves to periphery 

(glands, smooth muscle) 

Thoracic visceral plexuses 

Heart 

L2 

Prevertebral plexus 

Abdominal viscera 

Sympathetic ganglion 

Sympathetic trunk 

Preganglionic sympathetic 

Postganglionic sympathetic 

Ganglion impar 

Pelvic viscera 

14 

All sympathetic visceral efferent (motor) nerves originate from 

spinal levels T1–L2 and pass into the associated spinal nerves


[VII] 

[III] 

Pterygopalatine 

ganglion 

[IX] 

Ciliary ganglion 

Otic ganglion 

Pupillary constriction 

Lacrimal gland 

Parotid gland 

Sublingual gland 

Cranial 

parasympathetic 

outflow via 

cranial nerves 

[X] 

Submandibular 

ganglion 

Sumandibular gland 

Thoracic visceral plexuses 

Heart 

Transition from supply 

by [X] to pelvic splanchnic nerves 

Sacral 


outflow via pelvic 

splanchnic nerves 



Synapse with nerve cells 

of enteric system 

S2–S4 

Preganglionic parasympathetic 

Postganglionic parasympathetic 

Pelvic viscera 

Erectile tissues of penis 

(or clitoris in women) 

All paraympathetic visceral efferent (motor) nerves emerge from the brain in 

cranial nerves III, VII, IX, and X and from spinal levels S2–S4 

15

THE BODY • Dermatomes 

Cranial nerve [V] 

(Trigeminal nerve) 

[V 1 ] 

[V 2 ] 

C2 

[V 3 ] 

C3 

C5 

T1 

T2 

C2 

C3 

C4 

T2 

T3 

T4 

T5 

T6 

T7 

T8 

T9 

T10 

T11 

T2 

C5 

T1 

C5 

T1 

C4 

T2 

T3 

T4 

T5 

T6 

T7 

T8 

T9 

T10 

T11 

T12 

L1 

L2 

L3 

L4 

L5 

T1 

C5 

C6 

T12 

L1 

C6 

C6 

S3 

C6 

C8 

S4 

C8 

C7 

C8 

L2 

L2 

C8 

C7 

C7 

C7 

L3 

L3 

S2 

L3 L3 

S2 

Trigeminal 

L5 

L4 

L4 

L5 

Cervical 

Thoracic 

L5 

L5 

Lumbar 

Sacral 

L4 

L4 

S1 

S1 

Dermatome map 

(cutaneous distribution of nerves) 

S1 

S1 

16

Cutaneous nerves 1 

Intercostobrachial nerve T2 

Inferior lateral cutaneous 

nerve of arm C5,6 

Medial cutaneous 

nerve of forearm C8,T1 

Lateral cutaneous 

nerves T6–T11 


nerve of forearm C5,6 

Subcostal T12 

Palmar branch of median 

Palmar branch of ulnar 

Superior lateral cutaneous 


Superficial branch 

of radial C7,8 

Median C6,7,8 

Supraclavicular nerves 

(from cervical plexus) C3,4 

Lateral cutaneous nerves T3–T5 


nerve of arm C8,T1 

Lateral cutaneous branch 

of subcostal nerve (T12) 

Ulnar C8, T1 

Medial and 

intermediate 

cutaneous of 

thigh L2,3 

Infrapatellar branch of saphenous 

Lateral cutaneous of calf L5, S1,2 

Greater occipital nerve C2 

Third occipital nerve C3 

Posterior cutaneous 

branches C4–T6 

Anterior cutaneous 

branches of 

intercostal 

nerves T2–T11 


branches T7–T12 

Superior cluneal nerves 

L1–L3 

Medial cluneal nerves 

S1–S3 

Anterior cutaneous branch 


Iliohypogastric nerve L1 

Femoral branch of 

genitofemoral L1,2 

Inferior cluneal nerves 

Inguinal nerve L1 

S1–S3 


of thigh L2,3 

Obturator L2,3,4 

Medial cutaneous of thigh L2,3 

Supraclavicular nerve 

(from cervical plexus) C3,4 



Lateral cutaneous of thigh L2,3 

Saphenous L3,4 

Superior lateral 

cutaneous nerve of arm 

(from axillary nerve) C5,6 


nerve of arm C5,6,7,8 


nerve of arm C8,T1 

Intercostobrachial nerve T2 




nerve of forearm C5,6,7,8 


nerve of forearm C8,T1 


nerve of forearm C5,6 



of radial C6,7,8 

Dorsal branch of 

ulnar C8,T1 

Median 

C6,7,8 

Lateral sural cutaneous nerve 

L5, S1,2 


Superficial fibular L4,5, S1 

Sural communicating branch 

of common fibular 

Sural L5, S1,2 

Deep fibular 

Sural S1,2 

17

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2 

CONTENTS 

BACK 


Vertebral column 21 

Regional vertebrae 22 

Cervical vertebrae 23 

Thoracic vertebrae 26 

Lumbar vertebrae 28 

Sacrum 31 

Intervertebral foramina and discs 32 

Intervertebral disc problems 33 

Joints and ligaments 35 

Back musculature: surface anatomy 36 

Superficial musculature 37 

Intermediate musculature 39 

Deep musculature 40 

Back musculature: transverse section 42 

Suboccipital region 43 

Spinal nerves 44 

Spinal cord 45 

Spinal cord vasculature 46 

Venous drainage of spinal cord 47 

Meninges 48 

Spinal cord: imaging 50 

Transverse section: thoracic region 52 


Tables 54

BACK • Surface anatomy 

Ligamentum nuchae 

Acromion of scapula 


(spinous process of CVII) 



Spinous process of TXII 

Sacral dimple at posterior 

superior iliac spine 

Iliac crest 


20 

Surface anatomy of the back


2 

Anterior view 

Posterior view 

Lateral view 

CI (atlas) 

CII (axis) 

CI (atlas) 

CII (axis) 

CI (atlas) 

CII (axis) 

Cervical 

curvature 

Cervical 

vertebrae 

CVII 

TI 

CVII 

TI 

CVII 

TI 

Intervertebral disc 

Thoracic 

vertebrae 

Thoracic 

curvature 


TXII 

LI 

TXII 

LI 

TXII 

LI 

Lumbar 

curvature 

Lumbar 

vertebrae 

LV 

LV 

LV 

Promontory 

Sacrum 

Sacrum 

Sacral/coccygeal 

curvature 

Coccyx 

Coccyx 

21

BACK • Regional vertebrae 

Superior articular process 

Vertebral foramen 


7 cervical vertebrae 

(CI–CVII) 

Vertebral body 

Inferior articular process 

Foramen transversarium 

CV vertebra 

Transverse process 




Facet for articulation 

with tubercle of rib V 



12 thoracic vertebrae 

(TI–TXII) 


Demifacet for articulation 

with head of rib V 


with head of rib VI 

TV vertebra 




Pedicle 

5 lumbar vertebrae 

(LI–LV) 




Sacrum 

(5 fused sacral 

vertebrae I–V) 

LIII vertebra 

Coccyx 

(3–4 fused coccygeal 

vertebrae I–IV) 

22

Cervical vertebrae 

2 

Anterior tubercle 

of CI (atlas) 

Posterior tubercle of CI (atlas) 

CI (atlas) 

Lateral 

atlanto-axial 

joint 

CII (axis) 

Intervertebral 

disc 

CIII 

Anterior tubercle of CI (atlas) 

Dens of CII (axis) 

Body of CII (axis) 

Zygapophysial joint 

Posterior 

tubercle 


Spinous 

process 

of CII (axis) 

Spinal cord 

CIV 


foramen 

CV 


of CVI 

(carotid tubercle) 

CVI 

Foramen 

transversarium 

CVII 

Column of articular 

processes 


of CVII 

Spinous 

processes 



Cervical region of vertebral column. 

T1-weighted MR image in the sagittal plane 

Vertebra 

prominens 

(spinous 

process of 

CVII) 

Cervical vertebrae (lateral view) 




of CIII 

Vertebral body of CII (axis) 

Posterior 

tubercle 


Spinous 

process 


Intervertebral disc space 



Rib I 


Radiograph, AP view 

Vertebral body of CVII 


Radiograph, lateral view 

Vertebra 

prominens 

(spinous 


CVII)) 

23

BACK • Cervical vertebrae 


Articular facet for dens 


Anterior arch 

Tubercles for attachment of 

transverse ligament of atlas 

Lateral mass 

Anterior arch 

Superior articular facet 


Groove for vertebral artery 



Posterior arch 


Lateral mass 

Posterior tubercle 

CI vertebra (atlas; superior view) 

CI vertebra (atlas; anterior view) 

Anterior articular facet 

Dens 

Dens (odontoid process) 


Groove on posterior surface 

of dens for transverse 

ligament of atlas 



Facets for attachment 

of alar ligaments 


Interarticular part 



CII vertebra (axis; superior view) 

Body 

CII vertebra (axis; anterior view) 

Inferior articular facet 

Body 

Pedicle 

Body 

Uncinate process 




Groove for 

spinal nerve 



Lamina 




(bifid) 

Spinous process (bifid) 

CV vertebra (superior view) 


CV vertebra (anterior view) 


Body of vertebra 

CIV 

Joint capsule 

Uncovertebral joint 



CV 

Uncovertebral joint 

24 

CIV/CV vertebrae (anterior view) 

Inferior articular facet

Cervical vertebrae 

2 

Anterior 

Anterior tubercle of CI (atlas) 

Transverse process of CI (atlas) 


Median atlanto-axial joint 


Transverse ligament of atlas 

Posterior arch of CI (atlas) 


Posterior 

First cervical vertebra (atlas). 

CT image in axial plane 

Anterior arch of CI (atlas) 


Posterior arch of CI (atlas) 

Spinous process of CII (axis) 


Intervertebral disc space 

Cervical vertebrae CI–CIII. 


Anterior 






Lamina 


Posterior 

Typical cervical vertebra. 


25

BACK • Thoracic vertebrae 

TI 

TII 

Vertebral body of TI 

TIII 


TIV 


Intervertebral foramen 

TV 

TVI 

TVII 


Cerebrospinal fluid in 

subarachnoid 

space 

TVIII 

Spinal cord 

TIX 


TX 

Vertebral body of TIX 

(with compression 

fracture) 

TXI 

TXII 

Vertebral body of TXII 

Thoracic vertebrae (lateral view) 

Thoracic region of vertebral column. 

T2-weighted MR image in sagittal plane (compression fracture TIX) 


Body 

Superior vertebral notch 


with head of rib III 








Lamina 

Pedicle 

Body 


with tubercle of rib III 


with head of rib IV 

Inferior vertebral notch 



with tubercle of rib III 



26 

TIII vertebra (superior view) 

TIII vertebra (lateral view)

Thoracic vertebrae 

2 



of TI 



of TV 

Lamina 



Spinous 

process 


disc space 

Rib 


Pedicle 

TIII vertebra (posterior view) 



Head of rib 



Thoracic region of vertebral column. 




Tubercle of rib 

Thoracic vertebra with rib articulations. 



Body 


Costal facet 




Pedicle 

Body 


Superior articular 

facet 






TXII vertebra (superior view) 

TXII vertebra (lateral view) 

27

BACK • Lumbar vertebrae 



LI 

Vertebral body of LI 

LII 



LIII 



LIV 


disc 


Vertebral body of LV 

LV 

Lumbar vertebrae (lateral view) 

Lumbar region of vertebral column. 

T1-weighted MR image in sagittal plane 

Vertebral 

body of LI 

Spinal nerve 


Pedicle 



disc space 





Vertebral 

body of LV 


Intervertebral foramina of lumbar region of vertebral column. 


28 

Lumbar region of vertebral column. 

Radiograph, lateral view

Lumbar vertebrae 

2 


Body 

Pedicle 

Mammillary process 


Lamina 



LIV vertebra (superior view) 







LIV vertebra (posterior view) 


Psoas major 





Lamina 

Articulation of lumbar vertebrae. 

T1-weighted MR image in axial plane 

29

BACK • Lumbar vertebrae 



Pedicle 



Body 




LIV vertebra (lateral view) 




Transverse 

process 

Body 

Lamina 

Accessory process 

Pars interarticularis 



LIV vertebra (oblique view) 


Transverse 

process 

Lamina 

Pedicle 

Pars interarticularis 


Lumbar region of vertebral column (“Scottie dog”). 

Radiograph, oblique view 


30

Sacrum 

2 

Promontory 

Ala 

Sacral canal 


Articular facet for pelvic 

bone (sacro-iliac joint) 


Anterior sacral 

foramina 


Cornua 

Posterior sacral foramina 

Sacral cornua 


Lateral 

sacral crest 

Median 

sacral crest 

Intermediate 

sacral crest 

Sacral hiatus 

Cornua 

Coccyx 

Sacrum and coccyx (anterior view) 

Sacrum and coccyx (posterior view) 




Promontory 

Articular facet for 

pelvic bone 

(sacro-iliac joint) 

Sacrum 

Sacral cornua 

Cornua 


SI 

Sacral region of vertebral column. 


Sacrum and coccyx (lateral view) 

31

BACK • Intervertebral foramina and discs 


Nucleus pulposus 


Anulus fibrosus 




Spinal cord 

Spinal nerve 





Hyaline cartilage 

Anterior ramus 

Posterior ramus 


Transverse costal facet 


Inferior costal facet 


Superior costal facet 

Superior 

costotransverse 

ligament 

Radiate ligament 

of costovertebral joint 

Lateral 

costotransverse 

ligament 

Sympathetic trunk and ganglia 


Sacrum 

Gray and white rami communicantes 

Rib 

Intercostal nerve 

Intervertebral disc in lower lumbar 

region of vertebral column. 


Intervertebral foramina and discs in the thoracic region 

32 


Intervertebral disc problems 

2 

Spinal cord 

Vertebral canal 

containing 

cerebrospinal fluid 

and cauda equina 

Cauda equina 

LIV 

Herniation of 

nucleus pulposus 

LV 

LIV vertebra 

Disc protrusion 

Intervertebral disc protrusion in lower lumbar 



Vertebral canal containing 

cerebrospinal fluid 

and cauda equina 

Intervertebral disc protrusion 

(midsagittal section) 



Herniation of 

nucleus pulposus 

Defect in 

anulus fibrosus 

Compression of 

spinal nerve roots 

Dura 

Cauda equina 

Disc protrusion 

Intervertebral disc protrusion in lower lumbar 



Intervertebral disc protrusion (superior view) 

33 


BACK • Intervertebral disc problems 

Cauda equina 

LIV 

L4 

Herniation of nucleus 

pulposus of L4/L5 disc not 

affecting LIV spinal nerve but 

compressing LV and other 

nerves passing to lower levels 

L5 

LV 

Sacrum 

S1 

S2 

S3 

S4 

S5 

Co 

Intervertebral disc protrusion (posterior view) 

Nerve root Main weakness Reflex decreased Area of sensory decrease Disc involved 

C5 

C5 Deltoid (biceps) (biceps, pectoralis) Shoulder, upper lateral arm C4–C5 

C6 Wrist extension (biceps, brachioradialis) 1st and 2nd digits (lateral forearm) C5–C6 

C7 Triceps Triceps Third finger C6–C7 

C8 Intrinsic hand muscles 4th and 5th digits (medial forearm) C7–T1 

Clinically important nerve roots in the upper limb 

C7 

C5–C6 

C6 

Nerve root Main weakness Reflex decreased Area of sensory decrease Disc involved 

L4 Iliopsoas and quadriceps Patellar tendon 

(knee jerk) 

L5 

Dorsiflexion of foot at 

ankle (big toe extension, 

foot eversion and 

inversion) 

Knee, medial lower leg 

Dorsum of foot, big toe 

L3–L4 

L4–L5 

L4 

S1 

Plantar flexion of foot 

at ankle 

Achilles tendon 

(ankle jerk) 

Lateral foot, small toe, sole 

L5–S1 

S1 

L5 

Clinically important nerve roots in the lower limb 

34 


Joints and ligaments 

2 



Anterior longitudinal ligament 

Lumbar vertebral body 



facet 



Supraspinous ligament 

Interspinous ligament 


Posterior longitudinal 

ligament 

Ligamenta flava 


Capsule of 

zygapophysial joint 


Ligamentum nuchae and 

supraspinous ligament (lateral view) 

Supraspinous 

ligament 



Interspinous 

ligament 



Interspinous 

ligament 


Vertebral ligaments of the lumbar region 

(posterior oblique view) 

Supraspinous 

ligament 


Posterior longitudinal ligament 



35 


BACK • Back musculature: surface anatomy 





Trapezius 




Triangle of auscultation 



Humerus 



Iliac crest 

Posterior view of male showing surface projections of back muscles 

36 


Superficial musculature 

2 

Superior nuchal line 



Dorsal scapular nerve 

Trapezius 

Superficial branch of 

transverse cervical artery 


Deltoid 

Infraspinatus 

Teres major 


Accessory nerve [XI] 


Deep branch of transverse 

cervical artery (dorsal 

scapular artery) 


Triangle of auscultation 


Humerus 


Thoracolumbar fascia 


Lumbar triangle 

Superficial musculature – trapezius and latissimus dorsi 

37 


BACK • Superficial musculature 



Supraspinatus 







Teres minor 

Infraspinatus 


Rhomboid minor (cut) 


cervical artery (dorsal 

scapular artery) 

Rhomboid major (cut) 

Teres major 




Supraspinatus 

Teres minor 

Infraspinatus 


Teres major 



Superficial musculature – levator scapulae and rhomboid major and minor 

38

Intermediate musculature 

2 




Supraspinatus 



Serratus posterior superior 

Teres minor 

Infraspinatus 


Teres major 

Posterior layer of thoracolumbar fascia 


Serratus posterior inferior 


Iliac crest 

Intermediate musculature 

39

BACK • Deep musculature 







Longissimus capitis 



Iliocostalis cervicis 

Longissimus cervicis 


Longissimus 

Spinalis 

Spinalis thoracis 

Longissimus thoracis 

Iliocostalis thoracis 

Iliocostalis 

Iliocostalis lumborum 


Iliac crest 

Posterior superior iliac spine 

40 

Deep group of back muscles – erector spinae muscles

Deep musculature 

2 

Rectus capitis posterior minor 



Obliquus capitis superior 

Transverse process of CI (atlas) 

Rectus capitis posterior major 

Obliquus capitis inferior 



Semispinalis thoracis 

Rotatores thoracis 

(long, short) 

Levatores costarum 

(short, long) 

Multifidus 

Intertransversarius 

Quadratus lumborum 

Iliac crest 

Erector spinae (cut) 

Deep group of back muscles – transversospinales and segmental muscles 

41

BACK • Back musculature: transverse section 


Transversalis fascia 

Psoas major 

Skin 


Superficial fascia 




Anterior layer 

Middle layer 

Posterior layer 

Thoracolumbar 

fascia 


Transversospinales 

Thoracolumbar fascia and the deep back muscles 

(transverse section – lumbar region) 




Psoas major 







Lumbar region (LIII) showing back musculature. 


42

Suboccipital region 

2 

Third occipital nerve (posterior ramus of C3) 


Superior branch of the occipital artery 

Semispinalis capitis (cut) 

Greater occipital nerve 

(posterior ramus of C2) 



Splenius capitis (cut) 

Occipital artery 

Posterior ramus of C1 

Inferior branch of the 

occipital artery 





Obliquus capitis inferior 

Interspinalis cervicis 

Multifidus 


of temporal bone 







Semispinalis capitis (cut) 

Spinalis cervicis 

Sternocleidomastoid (cut) 

Splenius capitis (cut) 

Trapezius (cut) 

Semispinalis cervicis 

Suboccipital region 

43

BACK • Spinal nerves 

C1 

CI 

Relation of spinal nerve roots to vertebrae 

C2 

C3 

CII 

CIII 

Subarachnoid space 

Cervical 

nerves 

C4 

CIV 

C5 

CV 

C6 

CVI 

C7 

CVII 

C8 

TI 

T1 

TII 

T2 

TIII 

Cervical enlargement 

(of spinal cord) 

C1 

CI (atlas) 

C2 

CII (axis) 

C3 

CIII 

C4 

CIV 

C5 

CV 

C1 emerges 

between 

skull and CI 

vertebra 

C2–C7 emerge 

superior to 

pedicles 

Thoracic 

nerves 

T3 

T4 

T5 

T6 

T7 

T8 

T9 

TIV 

TV 

TVI 

TVII 

TVIII 

TIX 

C6 

C7 

C8 

T1 

T2 

CVI 

CVII 

TI 

TII 

Nomenclature of spinal nerves 


C8 emerges 

inferior to 

pedicle of CVII 

vertebra 

T1–Co emerge 

inferior to 

pedicles of 

their respective 

vertebrae 

TX 

T10 

TXI 

LIV 

Pedicle of vertebra 

T11 

T12 

TXII 

Lumbosacral enlargement 


L4 

LV 

L1 

LI 


L5 

LII 

Lumbar 

nerves 

L2 

L3 

LIII 

Cauda equina 

S1 

S2 

Sacrum 

L4 

LIV 

Filum terminale 

(pial part) 

S3 

LV 

S4 

L5 

S1 

SI 

SII 

SIII 

End of dural/arachnoid sac 

S5 

Co 


Coccyx 

Sacral and coccygeal 

nerves 

S2 

S3 

S4 

S5 

Co 

SIV 

SV 

Coccyx 


(dural part) 

Sacral and coccygeal nerves 

(posterior view – vertebral arches removed) 

44

Spinal cord 

2 

Spinal cord and spinal nerves in vertebral canal 

C1 

Central canal 

Anterior horn 

Cervical 

enlargement 


Anterior median fissure 

Anterior rootlets 

Gray matter 

White matter 

Posterior horn 

Pedicles of 

vertebrae 

C8 

T1 

Posterior rootlets 

Sympathetic 

trunk 


Anterior root 

Posterior root 

Spinal nerve 

Spinal 

ganglion 

Sympathetic 

ganglion 

White ramus 

communicans 


Posterior median sulcus 

Posterior intermediate sulcus 

Posterolateral sulcus 

Lumbosacral 

enlargement 



T12 

Gray ramus communicans 

Recurrent meningeal branches of 

spinal nerve 

Features of the spinal cord (thoracic region) and basic 

organization of a spinal nerve (posterior view) 

Cauda equina 

L1 



Anterior root 

Gray and white rami 

communicantes 

L5 

Spinal ganglion 

Spinal nerve 

S1 



S5 

Co 



Spinal nerves 

(transverse section) 



45

BACK • Spinal cord vasculature 

Posterior spinal artery 

Anterior spinal artery 


Segmental supply of 

spinal cord (posterior view) 

Segmental medullary 

arteries 

Anterior radicular artery 

Anterior radicular artery 

Right posterior 

intercostal artery 


Ascending cervical artery 

Deep cervical artery 

Costocervical trunk 

Segmental spinal artery 

Thyrocervical trunk 

Subclavian artery 

Posterior radicular artery 


Right posterior spinal artery 

Left posterior spinal artery 

Left posterior 



Segmental medullary arteries 

(branch from segmental spinal 

artery) 

Posterior intercostal artery 


Segmental medullary artery 

Right posterior spinal artery 

Segmental supply of 

spinal cord (anterior view) 

Left posterior spinal artery 

Sulcal (central) 

branches to spinal cord 


Artery of Adamkiewicz 

(branch from 

segmental 

spinal artery) 

Segmental 

spinal artery 


Anastomotic loops to 

posterior spinal arteries 

Anterior 

radicular artery 

Pia arterial plexus 

Segmental 

spinal artery 



Anterior 

radicular artery 

Segmental 

spinal artery 

Segmental 

medullary artery 

Lateral sacral artery 

Segmental 

medullary artery 

Right posterior 

intercostal arteries 


Arteries that supply the spinal cord 


Left posterior 

intercostal arteries 

Segmental 

spinal artery 

46

Venous drainage of spinal cord 

2 

Anterior internal vertebral plexus 

Anterior external 

vertebral plexus 

Dura mater 

Posterior internal vertebral plexus 

Basivertebral vein 

Spinal nerve 

Accessory hemi-azygos vein 

Vertebral venous plexus 

(left posterolateral view) 

Intervertebral vein 

Posterior intercostal vein 



Vein connecting to posterior 

external venous plexus (not shown) 

Basivertebral vein 

Anterior spinal vein 

Posterior longitudinal ligament 

Dura mater 

Anterior internal vertebral plexus 

Intervertebral vein 

Anterior radicular vein 

Posterior radicular vein 

Extradural fat 

Posterior sulcal (central) vein 

Posterior internal vertebral plexus 

Posterior spinal vein 

Veins that drain the spinal cord 


47

BACK • Meninges 


Pia mater 

Arachnoid mater 

Dura mater 

Subarachnoid 

space 


foramen 

Cord and meninges at thoracic level 


Dura mater 

Pia mater 


Dura mater 

End of spinal cord 

at vertebrae LI–LII 

Cauda equina 


(pial part) 

Cauda equina and meninges at lumbar level 

Anterior sacral foramen 

Sacral spinal nerve 


End of subarachnoid 

space–sacral 

vertebra II 


Posterior sacral foramen 

Nerve root 

Dura mater 

Filum terminale (dural part) 

Nerve roots and meninges at sacral level 

48

Meninges 

2 



Arachnoid trabeculae 

Pia mater 

Posterior spinal arteries 

Denticulate ligament 

Anterior root 




Dura mater 

Spinal nerve 

Recurrent meningeal branches 

of spinal nerve 

Meninges covering parts of the thoracic region of the spinal cord (posterior view) 

49

BACK • Spinal cord: imaging 

Cerebellum 




subarachnoid space 

Spinal cord 

Cervical enlargement 

of spinal cord 

Vertebral body of CVII 




Cervical and upper thoracic vertebral column showing 

upper and middle portions of spinal cord. 


50

Spinal cord: imaging 

2 

Vertebral body of 

thoracic vertebra 

Spinous process of 

thoracic vertebra 

Spinal cord 

Cerebrospinal fluid 



Lumbosacral enlargement 


Thoracic and upper lumbar vertebral 

column showing middle and lower portions 

of spinal cord and its termination. 


Cauda equina 

Spinal cord 




lumbar cistern 

Cauda equina 



lumbar vertebra 

SI 

End of dural/arachnoid sac 

Lumbar and sacral vertebral column showing 

termination of spinal cord and continuation 

and termination of dural/arachnoid sac. 


51

BACK • Transverse section: thoracic region 




Posterior intercostal artery 


Azygos vein 


Accessory 

hemi-azygos vein 

Left lung 

Innermost intercostal 



Right lung 

Visceral 

Parietal 

White and gray rami communicantes 

Spinal nerve 



Pleura 

Teres major 

Subscapularis 

Scapula 


Infraspinatus 

Posterior cutaneous branch of 

posterior ramus of spinal nerve 

Trapezius 



Transverse section through thoracic region of vertebral column 

Right lung 


Left lung 

Scapula 

Rhomboid 

Trapezius 



Thoracic region of back. 


52

Dermatomes and cutaneous nerves 

2 

Greater occipital nerve C2 

Third occipital nerve C3 

C3 

C4 

T2 

T3 

Trapezius 

Posterior cutaneous branches C4–T6 

T4 

T5 

T6 

T7 

T8 

T9 

T10 

T11 

T12 



branches T7–T12 

L1 

L2 

L3 

L4 

L5 

Superior cluneal nerves L1–L3 


S3 

Medial cluneal nerves S1–S3 

S4 


S1–S3 

Dermatomes and cutaneous nerves of the back 

53

BACK • Tables 

Superficial (appendicular) group of back muscles 

Muscle Origin Insertion Innervation Function 

Trapezius 

1 

Superior nuchal line, external 

occipital protuberance, 

ligamentum nuchae, spinous 

processes of CVII to TXII 

Lateral one third of clavicle, 

acromion, spine of scapula 

Motor—accessory 

nerve [XI]; 

proprioception— 

C3 and C4 

Assists in rotating the scapula 

during abduction of humerus 

above horizontal; upper fibers 

elevate, middle fibers adduct, 

and lower fibers depress 

scapula 


2 

Spinous processes of TVII to 

LV and sacrum, iliac crest, 

ribs X to XII 

Floor of intertubercular sulcus 

of humerus 

Thoracodorsal 

nerve (C6 to C8) 

Extends, adducts, and 

medially rotates humerus 


3 

Transverse processes of 

CI to CIV 

Upper portion of medial border 


C3 to C4 and 

dorsal scapular 

nerve (C4, C5) 

Elevates scapula 


4 

Spinous processes of 

TII to TV 

Medial border of scapula 

between spine and inferior 

angle 

Dorsal scapular 


Retracts (adducts) and 

elevates scapula 


5 

Lower portion of ligamentum 

nuchae, spinous processes of 

CVII and TI 

Medial border of scapula at 

the spine of scapula 



Retracts (adducts) and 

elevates scapula 

Intermediate (respiratory) group of back muscles 

Serratus 

posterior 

superior 

6 

Lower portion of ligamentum 


CVII to TIII and supraspinous 

ligaments 

Mastoid process, skull below 

lateral one third of superior 

nuchal line 

Anterior rami of 

upper thoracic 

nerves (T2 to T5) 

Elevates ribs II to V 

Serratus 

posterior 

inferior 

7 

Spinous processes of TXI to 

LIII and supraspinous 

ligaments 

Lower border of ribs IX to XII 

just lateral to their angles 


lower thoracic 


Depresses ribs IX to XII and 

may prevent lower ribs from 

being elevated when the 

diaphragm contracts 

Spinotransversales muscles 


8 

Lower half of ligamentum 


CVII to TIV 

Mastoid process, skull below 

lateral one third of superior 

nuchal line 

Posterior rami 

middle cervical 

nerves 

Together—draw head 

backward, extending neck; 

individually—draw and rotate 

head to one side (turn face to 

same side) 


9 

Spinous processes of TIII 

to TVI 

Transverse processes of 

CI to CIII 

Posterior rami 

lower cervical 

nerves 

Together—extend neck; 

individually—draw and rotate 

head to one side (turn face to 

same side) 

54

Tables 

2 

1 

3 

5 

6 

4 

2 

7 

8 

9 

55


Erector spinae group of back muscles 

Muscle Origin Insertion 

Iliocostalis lumborum 

1 

Sacrum, spinous processes of lumbar and lower two 

thoracic vertebrae and their supraspinous ligaments, and 

the iliac crest 

Angles of the lower six or seven ribs 

Iliocostalis thoracis 

2 

Angles of the lower six ribs 

Angles of the upper six ribs and the transverse 

process of CVII 


3 

Angles of ribs III to VI 

Transverse processes of CIV to CVI 

Longissimus thoracis 

4 

Blends with iliocostalis in lumbar region and is attached to 

transverse processes of lumbar vertebrae 

Transverse processes of all thoracic vertebrae 

and just lateral to the tubercles of the lower nine 

or ten ribs 

Longissimus cervicis 

5 

Transverse processes of upper four or five thoracic 

vertebrae 

Transverse processes of CII to CVI 


6 

Blends with iliocostalis in lumbar region and is attached to 

transverse processes of lumbar vertebrae 

Transverse processes of all thoracic vertebrae 

and just lateral to the tubercles of the lower nine 

or ten ribs 

Spinalis thoracis 

7 

Spinous processes of TX or TXI to LII 

Spinous processes of TI to TVIII (varies) 

Spinalis cervicis 

8 

Lower part of ligamentum nuchae and spinous process of 

CVII (sometimes TI to TII) 


Spinalis capitis 

9 

Usually blends with semispinalis capitis 

With semispinalis capitis 

Transversospinales group of back muscles 

Semispinalis thoracis 

10 

Transverse processes of TVI to TX 

Spinous processes of upper four thoracic and 

lower two cervical vertebrae 

Semispinalis cervicis 

11 

Transverse processes of upper five or six thoracic 

vertebrae 

Spinous processes of CII (axis) to CV 


12 

Transverse processes of TI to TVI (or TVII) and CVII and 

articular processes of CIV to CVI 

Medial area between the superior and inferior 

nuchal lines of occipital bone 

Multifidus 

13 

Sacrum, origin of erector spinae, posterior superior iliac 

spine, mammillary processes of lumbar vertebrae, 

transverse processes of thoracic vertebrae, and articular 

processes of lower four cervical vertebrae 

Base of spinous processes of all vertebrae from 

LV to CII (axis) 

Rotatores lumborum 

14 

Mammillary processes of lumbar vertebrae 

Spinous processes of lumbar vertebrae 

Rotatores thoracis 

15 

Transverse processes of thoracic vertebrae 

Spinous processes of thoracic vertebrae 

Rotatores cervicis 

16 

Articular processes of cervical vertebrae 

Spinous processes of cervical vertebrae 

56

Tables 

2 

6 

9 

8 

3 

12 

11 

5 

10 

2 

4 

7 

1 

16 

15 

13 

14 

57


Segmental back muscles 

Muscle Origin Insertion Function 

Levatores costarum 

1 

Short paired muscles arising 

from transverse processes of 

CVII to TXI 

The rib below vertebra of origin 

near tubercle 

Contraction elevates rib 

Interspinales 

2 

Short paired muscles attached to 

the spinous processes of 

contiguous vertebrae, one on each 

side of the interspinous ligament 

Postural muscles that stabilize adjoining 

vertebra during movements of 

vertebral column 

Intertransversarii 

3 

Small muscles between the 

transverse processes of 

contiguous vertebrae 

Postural muscles that stabilize adjoining 

vertebra during movements of 


2 

1 

3 

2 

58

Tables 

2 

Suboccipital group of back muscles 


Rectus capitis 

posterior major 

1 


axis (CII) 

Lateral portion of occipital bone 

below inferior nuchal line 


of C1 

Extension of head; rotation 

of face to same side as muscle 


posterior minor 

2 

Posterior tubercle of 

atlas (CI) 

Medial portion of occipital bone 

below inferior nuchal line 



Extension of head 

Obliquus capitis 

superior 

3 

Transverse process of 

atlas (CI) 

Occipital bone between 

superior and inferior nuchal 

lines 



Extension of head and bends it to 

same side 

Obliquus capitis 

inferior 

4 


axis (CII) 

Transverse process of atlas (CI) 



Rotation of face to same side 

3 

2 

4 

1 

59


3 

CONTENTS 

THORAX 


Bony framework 63 

Ribs 65 

Articulations 66 

Breast 68 


Thoracic wall muscles 72 

Diaphragm 73 

Arteries of the thoracic wall 74 

Veins of the thoracic wall 75 

Nerves of the thoracic wall 76 

Lymphatics of the thoracic wall 77 

Intercostal nerves and arteries 78 

Pleural cavities and mediastinum 79 

Parietal pleura 80 

Surface projections of pleural recesses 81 

Right lung 82 

Left lung 83 

Lung lobes: surface relationship 84 

Lung lobes: imaging 85 

Bronchial tree 86 

Bronchopulmonary segments 87 

Pulmonary vessels and plexus 88 

Pulmonary vessels: imaging 89 

Mediastinum 91 

Pericardium 92 

Pericardial layers 93 

Anterior surface of heart 94 

Base and diaphragmatic surface of heart 95 

Right atrium 96 

Right ventricle 97 

Left atrium 98 

Left ventricle 99 

Aortic valve and cardiac skeleton 100 

Cardiac chambers and heart valves 101 

Coronary vessels 102 

Coronary arteries and variations 103 

Cardiac conduction system 105 

Auscultation points and heart sounds 106 

Cardiac innervation 107 

Superior mediastinum: thymus 108 

Superior mediastinum: veins and arteries 109 

Superior mediastinum: arteries and nerves 110 

Superior mediastinum: imaging 111 

Superior mediastinum: veins and trachea 112 


Mediastinum: view from right 114 

Mediastinum: imaging – view from right 115 

Mediastinum: view from left 116 

Mediastinum: imaging – view from left 117 

Posterior mediastinum 118 


Transverse section: TVIII level 124 


Visceral efferent (motor) innervation of the heart 126 

Visceral afferents 127 

Tables 128

THORAX • 

Surface anatomy with bones 

1 

I 

Jugular notch 

Sternoclavicular joint 

Clavicle 

Acromioclavicular joint 



II 

Sternal angle 

III 

IV 


V 

VI 

Xiphoid process of sternum 

VII 

VIII 

Costal margin 

IX 

X 

Anterior chest wall in a woman 

2 

I 

Jugular notch 


Clavicle 



II 


Sternal angle 

III 

IV 


Fourth intercostal space 

V 

VI 

Xiphoid process of sternum 

VII 

VIII 

Costal margin 

IX 

X 

Anterior chest wall in a man 

62

Bony framework 

3 

Clavicle 

Vertebra TI 

Superior thoracic aperture 

(indicated by red line) 

Rib I 

Vertebra TI 


Clavicle 

Rib I 

Scapula 

3 

Manubrium of 

sternum 



4 


Inferior angle 


Inferior thoracic 

aperture 

(indicated by red line) 

Rib XI 

Rib XII 

Vertebra TXII 

Bony framework of thorax 


Rib XII 



Bony framework of thorax 


Trachea 

Clavicle 

Rib 


Aortic arch 

5 

Pulmonary trunk 

Right atrium 


Right dome of diaphragm 

Left ventricle 

Left dome of diaphragm 

Costodiaphragmatic recess 

Positioning of structures in chest. 


63

THORAX • 

Bony framework 


True ribs 

I–VII 

TI 

Costovertebral joint 

6 



with tubercle of rib II 



with head of rib II 

Body 

I 

II 

Intercostal space 


Sternocostal joint 





TII vertebra (lateral view) 

Jugular notch 

7 

III 

IV 

Articular site 

for clavicle 

Attachment 

site for rib I 

10 


V 

Costal cartilage 

VII 

VI 

TXII 

XI 

Articular demifacets 

for rib II 

Sternal angle 

(manubriosternal 

joint) 

VIII 

XII 

Sternum 

False ribs 

VIII–XII 

IX 

Floating ribs 

Transverse ridges 

X 

Costal margin 

Articular facets for 

ribs III–VI 

Body of 

sternum 




with head of rib X 


rib VII 

Xiphisternal joint 


with tubercle of rib X 


64 




TX vertebra (lateral view) 

9 

Body 








with head of rib XII 

TXII vertebra (lateral view) 

Body 



9

Ribs 

3 

Neck 

Tubercle 

Head with articular facet 

Head with 

articular facet 

Neck 

Area for attachment of 

middle scalene 

Groove for subclavian artery 

Scalene tubercle (attachment 

of anterior scalene) 

Groove for subclavian vein 

Rib I (superior surface) 


Tubercle 

11 

Crest 

Area for attachment of 

posterior scalene 

Areas for attachment of 

serratus anterior 


vertebral body 

Articular facet for transverse 

process of vertebra 

Inferior surface 


Angle 

Neck 



Head 

12 

Rib I (posterior view) 

Internal surface 


Rib II (superior surface) 

Tubercle 

Crest 

Costal groove 

External surface 

Articular facets for vertebral body 

Nonarticular surface 

Articular facet for transverse 

process of vertebra 

Internal surface 

13 


Rib V (anterior view) 

External surface 

Costal groove 

Rib V posterior view 

14 




Rib XII (anterior view) 

65

THORAX • 

Articulations 


Costal facet of 

transverse process 

Superior costal facet 

15 


Sternal angle 

Facet on inferior 

articular process 

Inferior costal demifacet 




Superior costotransverse ligament 

Rib V 



Costovertebral and sternocostal joints 



16 


Sternum 

Accessory 

ligament 


disc 


of thoracic vertebra 

Tubercle of rib 

Scapula 

Rib 


18 

Paired synovial joints 

Costovertebral joints 

(lateral view) 

intra-articular ligament 

17 


66 

Body of thoracic vertebra 

Articulation of rib with thoracic vertebra (TIV). 


Lateral costotransverse ligament 

Costotransverse ligament 

Costovertebral joints 

(superior view) 

Synovial joint cavities

Articulations 

3 

Fibrocartilaginous joint 

Costochondral junctions 

Synovial joint 

(two compartments) 

and intra-articular ligament 

Sternal angle 

Manubriosternal joint 

(symphysis) 

Radiate sternocostal 

ligaments 

Synovial joint 

Xiphisternal joint 

(symphysis) 

19 

Costoxiphoid ligament 

Costochondral junction 

Sternum 


Interchondral joints 

Rib 

20 

Sternocostal and interchondral joints 

Scapula 

Thoracic vertebra 

Articulation of costal cartilage with sternum. 


67

THORAX • 

Breast 


Axillary process 

21 22 

Areola 

Nipple 

Anterior view 



Rib II 


Suspensory ligament 

24 

Axilla 

23 

Deep (pectoral) fascia 

Retromammary 

(submammary) space 

Nipple 

Lateral view 

Lactiferous sinuses 

Intercostal muscles 

Lactiferous ducts 

Rib VI 

Secretory lobules of mammary gland 

68 

Sagittal section

Breast 

3 

Pectoral branch of 

thoraco-acromial artery 



Left parasternal lymphatic vessel 

Left subclavian (lymphatic) trunk 

Apical axillary nodes 

Lateral thoracic artery 

Central axillary nodes 


Lateral axillary 

nodes 

25 


Second thoracic 

intercostal nerve 

Fourth thoracic 


Subscapular axillary 

nodes 

Pectoral axillary nodes 

Drains to opposite side 

Areola 

Sixth thoracic intercostal nerve 

Drains into abdominal 

lymphatics 

Parasternal nodes 

Arteries and innervation of breast 

Lateral (axilla) 

Mammary branches of 

internal thoracic artery 

Lymphatic drainage of breast 

Head (superior) 

Pectoralis 

major 

Nipple 

26 

Nipple profile 

Retromammary 

(submammary) 

space 

27 

Medial (sternum) 

Mammography. Craniocaudal (CC) view of a normal right 

breast showing a heterogeneously dense appearance 

Feet (inferior) 

Mammography. Mediolateral oblique (MLO) view of a normal 

right breast showing a heterogeneously dense appearance 

69

THORAX • 

Pectoral region 

Acromion 

Clavicle 


Subclavius 

Thoraco-acromial artery 


Lateral pectoral 

nerve 


Medial pectoral 

nerve 

Clavipectoral fascia 

Right humerus 


Left humerus 


Sternum 


Cut edge of pectoralis major 


External intercostal membrane 

28 

Pectoralis major muscle and related deep structures 

Sternum 





Scapula 

29 

Pectoralis major and minor muscles on anterior thoracic wall. 


70

Pectoral region 

3 

Clavicle 


Subclavius 




30 


Internal intercostal muscle covered 

by external intercostal membrane 

Pectoralis minor and the anterior thoracic wall 

(pectoralis major removed) 



31 




Muscles of the lateral thoracic wall 

(pectoralis major removed) 



Serratus posterior superior 


Posterior layer of 

thoracolumbar fascia 

covering 

Longissimus 

Iliocostalis 


Serratus posterior inferior 


32 

Muscles of the posterior thoracic wall 

71

THORAX • 

Thoracic wall muscles 


Rib I 

33 

Intercostal vein 

Intercostal artery 




34 




Costal groove 

Endothoracic fascia 



Parietal pleura 

Collateral branches 


External intercostals 

External intercostal membrane 

Intercostal muscles 

35 




Transversus thoracis 

Subcostals 

36 

Subcostal muscles of the 

posterior thoracic wall 

Transversus thoracis muscles of the 

anterior thoracic wall 

72

Diaphragm 

3 

Caval opening 

Central tendon of diaphragm 

37 

Central tendon of diaphragm 

Costal part of 

diaphragm 

Sternum 

Caval opening 

40 

Lumbar part of diaphragm 

Esophageal hiatus 

Aortic hiatus 

Diaphragm (superior view) 


Medial arcuate 

ligament 

LIII 

Rib XII 

Rib XI 

Lateral arcuate ligament 

Left crus 

Diaphragm within the rib cage 

Median arcuate ligament 

Aortic hiatus 


Right crus 

39 

38 

TVIII 

Right dome 

Rib V 

Left dome 

TX 

Esophageal 

hiatus 

Esophagus 

TXII 

Aortic hiatus 

Aorta 

Right crus 

Left crus 

Major structures that pass through the diaphragm 

Features of diaphragm 

73

THORAX • 

Arteries of the thoracic wall 

Right supreme intercostal artery 

Right costocervical trunk 


Right common carotid artery 

Left costocervical trunk 






Posterior intercostal arteries 

Internal thoracic arteries 

Anterior perforating 

branches 

Collateral branch of 

posterior intercostal artery 

41 

Anterior intercostal artery 

Collateral branch of 

anterior intercostal artery 

Musculophrenic artery 

Right superior epigastric artery 

Arteries of the thoracic wall 

Abdominal aorta 






Thoracic vertebra 


42 

Right atrium 

Arteries of the thoracic wall. 

Volume-rendered right lateral view 

of structures in the thorax using 

multidetector computed tomography 

Right ventricle 


74

Veins of the thoracic wall 

3 

Left superior intercostal vein 

Left supreme intercostal vein 


Right internal jugular vein 



Right superior intercostal vein 



Accessory 


Posterior intercostal veins 

Internal 

thoracic veins 

Azygos vein 

44 43 

Anterior intercostal vein 

Right superior 

intercostal vein 

Hemi-azygos vein 

Azygos vein 

Left superior 


Accessory 


Right superior epigastric vein 

Right musculophrenic vein 


Left subcostal vein 

Posterior intercostal veins 


Veins of the thoracic wall 

Right 

subcostal vein 

Left ascending lumbar vein 


Right ascending 

lumbar vein 

Azygos system of veins 

75

THORAX • Nerves of the thoracic wall 

Spinal nerve 


Posterior branch of lateral 



branch of 


Anterior branch 

of lateral 


Small collateral branch 

of intercostal nerve 



(intercostal nerve) 

Intercostal 

nerve 


Medial cutaneous branch 

of posterior ramus 

45 


of posterior ramus 

Posterior branch of 

lateral cutaneous nerve 


Spinal cord 

Anterior 

cutaneous 



Subcostal nerve (T12) 

Nerves of the thoracic wall 

Spinal nerve 

Intercostal nerve (anterior ramus of 

thoracic spinal nerve) 


46 




branch of intercostal 

nerve 

Anterior branch of 


Medial branch of 

anterior cutaneous nerve 

Lateral branch of 

anterior cutaneous nerve 

Intercostal nerves and branches 

76

Lymphatics of the thoracic wall 

3 

Thoracic duct 


Right jugular trunk 

Right subclavian trunk 

Right bronchomediastinal 

trunk 

Brachiocephalic nodes 

Right parasternal 

lymphatic vessel 


47 


Thoracic duct 




Right bronchomediastinal trunk 

Left jugular trunk 


tracheobronchial nodes 

Left subclavian trunk 


Left bronchomediastinal 

trunk 

Left parasternal 

lymphatic vessel 

Lymph nodes and 

vessels of the trachea 

Parasternal nodes 

Inferior 

tracheobronchial 

nodes 

Thoracic duct 

Right 

paratracheal 

nodes 

48 

Thoracic duct 

Intercostal 

nodes 

Diaphragmatic nodes 

Diaphragm 


Lateral aortic nodes 



Right subclavian trunk 

49 


Left jugular trunk 

Left subclavian trunk 



Major lymphatic vessels and nodes 

of the thoracic wall 

Right lymphatic duct 

Right bronchomediastinal trunk 

Left bronchomediastinal 

trunk 

Thoracic duct 


Termination of the lymphatic trunks 

77

THORAX • 

Intercostal nerves and arteries 



Posterior ramus of spinal nerve 



White ramus communicans 




Innermost 

intercostal 


membrane 

Spinal nerve 




50 




Anterior cutaneous branch of intercostal nerve 



Sternum 

Lateral branch of anterior cutaneous nerve 

Medial branch of anterior cutaneous nerve 


Posterior branch of posterior intercostal artery 



posterior intercostal 

artery 

Innermost 

intercostal 

Posterior 


Collateral branch 


membrane 

51 


Intercostal arteries 

Anterior intercostal artery 



Sternum 

Anterior perforating branch 

78

Pleural cavities and mediastinum 

3 

Apex of right lung 

Right main bronchus 

Trachea 

Left pleural cavity 


Pleural cavity 

Visceral pleura 

52 

53 

Mediastinum 


(on thoracic wall) 

Mediastinum 

Costomediastinal recess 


(on lung) 

Costomediastinal 

recess 

Diaphragm 


54 

Right lung 

Left lung 

Pleural cavities 

Heart in mediastinum 

Right lung 

Mediastinum 

Left lung 

55 56 

Right lung 

Left lung 

Organization of the thoracic cavity. 


Right dome of diaphragm 

Left dome of diaphragm 

Organization of the thoracic cavity. 


79

THORAX • 


Cervical pleura 

(cupula) 

57 

Costal pleura 

Space for root of lung 

Pulmonary ligament 

Mediastinal pleura 

Costal pleura (cut) 

Suprapleural membrane 

Costal pleura (cut) 

CVII 

TXII 

Diaphragmatic pleura 

Parietal pleural reflections and recesses 

Costomediastinal 

recess 

Costodiaphragmatic 

recess 

Rib VI 

Rib VIII 

58 

Rib X 

80

Surface projections of pleural recesses 

3 

59 

Horizontal fissure 

Costomediastinal recess 

Rib VI 

Oblique fissure 

Rib VIII 


Rib X 


Surface projections of the pleura and lungs (anterior view) 

60 

TIV 

Rib V 


Rib VI 

61 

TX 

TXII 

Spinous process of TIV 

Rib V 


Rib VI 

Rib VIII 

Surface projections of the pleura and lungs (posterior view) 


Rib X 

Surface projections of the 

pleura and right lung (lateral view) 

81

THORAX • 

Right lung 

Superior lobe 

62 


Middle lobe 


Middle lobe 

Superior lobe 


Hilum 

Inferior lobe 

63 

Lobes of the right lung (anteromedial view) 

Inferior lobe 




Rib I 

Right lung (lateral view) 





Arch of azygos vein 

Costal cartilage of rib I 




Bronchus to superior lobe 

Pulmonary artery 


Pulmonary veins 

Bronchial arteries 

Bronchus to middle 

and inferior lobes 

Hilum 

Esophagus 

Cardiac impression 

Azygos vein 



Diaphragmatic surface 

64 


Inferior border 

Right lung and related structures (medial view) 

82

Left lung 

3 


Hilum 

Inferior lobe 

Superior lobe 

66 

Lingula 


Superior lobe 

Cardiac notch 

Lobes of the left lung (anteromedial view) 

Rib I 

Lingula 


Inferior lobe 

65 

Left lung (lateral view) 



Costal cartilage of rib I 







Bronchus 

Posterior intercostal 

arteries and veins 


Hilum 


Cardiac impression 

Esophagus 


Cardiac notch 



Lingula 


Left lung and related structures (medial view) 

Diaphragmatic surface 

67 

83

THORAX • 

Lung lobes: surface relationship 

Superior lobe of right lung 


Rib IV 

Middle lobe of right lung 

Rib V 


Inferior lobe of right lung 

Superior lobe of left lung 

Rib IV 

Rib V 


Inferior lobe of left lung 

68 

Surface projections of the lobes and fissures of the lungs (anterior view) 

CVII 


Rib V 


Rib VI 

TIV 





Rib X 

TX 

69 

Surface projections of the lobes and fissures of the lungs (posterior view) 

84

Lung lobes: imaging 

3 




70 





Right lung and left lung demonstrating superior and inferior lobes. The oblique fissures are visible. 


71 







Right lung demonstrating superior, middle, and inferior lobes and the left lung demonstrating 

superior and inferior lobes. The oblique fissure associated with the left lung is visible. 


72 






Right lung demonstrating middle and inferior lobes and the left lung demonstrating 

superior and inferior lobes. The oblique fissures are visible. 


85

THORAX • 

Bronchial tree 

Superior thyroid notch 

73 

Right lamina of thyroid cartilage 

Superior horn of thyroid cartilage 

Left lamina of thyroid cartilage 

Cricothyroid ligament 

Arch of cricothyroid cartilage 

Longitudinal folds of mucosa 

Cricotracheal ligament 

Tracheal cartilage (cut) 

Cut edge of mucosa 

Annular ligaments of trachea 

75 

Inferior horn of 

thyroid cartilage 

Cricothyroid articular capsule 

Tracheal cartilages 

Fibromuscular posterior wall 

Tracheal cartilages 

Tracheal mucosa 

74 

Tracheal mucosa 


Tracheal bifurcation 

Left main bronchus 

Trachea 



Branches of 

right superior 

lobar bronchus 

Branches of left superior 



right middle 



right inferior 


Branches of left 

inferior lobar 

bronchus 

Bronchial 

cartilages 

Trachea and bronchial tree 

86

Anterior segment (S III) 

Apical segment (S I) 

Superior lobe 

76 

Posterior segment (S II) 

Superior segment (S VI) 

Bronchopulmonary segments 

Apicoposterior segment (S I & II) 

Superior lobe 


3 

77 

Medial segment 

(S V) 

Middle lobe 

Superior segment (S VI) 

Inferior lobe 

Inferior lobe 

Posterior basal 

segment (S X) 

Superior lingular 

segment (S IV) 

Inferior lingular 

segment (S V) 

Medial basal 

segment (S VII) 


segment (S X) 

Anterior basal 

segment (S VIII) 

Anterior basal segment (S VIII) 

Lateral basal segment (S IX) 


Medial basal segment (S VII) 

Right lung (medial view) 

Left lung (medial view) 


Posterior 

segment (S II) 

Apicoposterior segment (S I & II) 


80 


Lateral segment (S IV) 

Medial segment (S V) 



Superior 

segment (S VI) 

Superior 

segment (S VI) 


segment (S X) 

Medial basal 

segment (S VII) 

Superior lingular segment (S IV) 

Inferior lingular segment (S V) 



78 


Posterior segment (S II) 

Superior segment 

(S VI) 

Inferior lobe 


segment (S X) 

Lateral basal 

segment (S IX) 

Superior lobe 

Right lung (lateral view) 


Medial 

segment 

(S V) 

Lateral 



Posterior basal segment (S X) 

Middle lobe 


Superior lingular 


Inferior lingular 

segment (S V) 

Anterior basal 

segment (S VIII) 

Bronchopulmonary segments 

Superior lobe 


Left lung (lateral view) 

Apicoposterior segment 

(S I & II) 

Superior segment 

(S VI) 

Inferior lobe 


segment (S X) 

79 

87

THORAX • 

Pulmonary vessels and plexus 

Trachea 



Apex of right lung 


Apex of left lung 


81 



Cut surface of right lung 

Cut surface of left lung 




Right pulmonary artery 

Right middle 


Right pulmonary veins 

Right inferior 



Left pulmonary artery 

Left superior lobar 

bronchus 

Left superior lobar 

bronchus 

(lingula division) 

Left pulmonary veins 

Left inferior lobar 

bronchus 


Diaphragmatic 

surface 

Esophagus 

Right cervical cardiac nerves from 

vagus and sympathetic trunk 

Right recurrent laryngeal nerve 

Right sympathetic trunk 

Pulmonary vessels 

Left cervical cardiac nerves from 

vagus and sympathetic trunk 

First thoracic sympathetic ganglion 

Left sympathetic trunk 


82 


Left vagus nerve 


Left recurrent laryngeal nerve 

Right vagus nerve 

Branches to cardiac and pulmonary plexuses 

Branch to left plexus from 

recurrent laryngeal nerve 

Cardiac plexus 

Anterior pulmonary plexus 

Anterior pulmonary plexus 


Right main broncus 



Fifth thoracic sympathetic ganglion 

Posterior pulmonary plexus 

Esophagus 




88 

Pulmonary plexus

Pulmonary vessels: imaging 

3 

A 

83 




Esophagus 





B 

84 



Right superior pulmonary vein 





Left superior pulmonary vein 


Esophagus 


C 

85 







Esophagus 





A through C – Relationships of the pulmonary arteries, pulmonary veins, and bronchi in the mediastinum. 

CT images, with contrast, in axial plane 

89

THORAX • 

Pulmonary vessels: imaging 

D 

86 







Esophagus 





E 

87 



Right atrium 

Left atrium 




Esophagus 



Bronchi 



F 

88 


Right atrium 


Left atrium 

Left inferior pulmonary vein 

Esophagus 


90 

D through F – Relationships of the pulmonary arteries, pulmonary veins, and bronchi in the mediastinum. 

CT images, with contrast, in axial plane

Mediastinum 

3 

Esophagus 





Trachea 






Sternal angle 

Branches of right 

pulmonary artery 





Heart 

Diaphragm 

89 

Structures of the mediastinum as they relate to the surface 

Superior mediastinum 

Sternal angle 

I 

II 

III 

IV 

V 

Anterior mediastinum 

90 91 

Inferior mediastinum 

VI 

VII 

VIII 

IX 

Middle mediastinum 

Posterior mediastinum 

Middle 

mediastinum 

X 

Anterior mediastinum 

XII 

XI 

Posterior 

mediastinum 

Diaphragm 

Subdivisions of the mediastinum 

(sagittal section) 

Subdivisions of the mediastinum 


91

THORAX • 

Pericardium 

Trachea 


Cervical parietal pleura 

Right phrenic nerve 



Cervical parietal pleura 

Left phrenic nerve 


92 

Right internal thoracic artery 




Left internal thoracic artery 



Ligamentum arteriosum 



Right 

pericardiacophrenic 

vessels 

Right phrenic 

nerve and 


artery and vein 

Diaphragm 


Left 


vessels 

Fibrous pericardium 

Cut edge of 

costal pleura 

Esophagus 



Pericardium with nerves and vessels 


93 





Right atrium 


92 

Mediastinal structures and lungs. 

CT image, with contrast, in coronal plane

Pericardial layers 

3 

Junction between fibrous 

pericardium and adventitia 

of great vessels 

94 

Fibrous pericardium 

Pericardial cavity 

Visceral layer of serous 

pericardium (epicardium) 

Myocardium 

Trachea 

Aorta 


Transverse pericardial sinus 

Oblique pericardial sinus 

Left atrium 

Parietal layer of serous 

pericardium 

Endocardium 

Subepicardial fat 


Esophagus 


Diaphragm 




Sagittal section of the pericardium and heart 

95 


Transverse pericardial sinus 








mediastinal pleura 

Cut edge of parietal pleura 


Cut edge of fibrous 

pericardium and 

parietal layer of 

serous pericardium 

Diaphragm 

Esophageal prominence 

Cut edge of fibrous 

pericardium and 

parietal layer of 

serous pericardium 


Pericardial sac with heart removed 

93

THORAX • 

Anterior surface of heart 

Cut edge of pericardium 


96 






Right atrium 





Left auricle 


Coronary sulcus 

Right coronary artery 

Anterior interventricular 

branch of left coronary artery 

(left anterior descending) 

Great cardiac vein 


sulcus (containing vessels) 


Obtuse margin 

Small cardiac vein 



Inferior margin 

Apex 

Anterior surface of the heart 

97 



Right auricle 

Right atrium 


Anterior interventricular branch 

of left coronary artery 




Anterior view of the heart. 

Volume-rendered anterior view using multidetector computed tomography 

94

Base and diaphragmatic surface of heart 

3 

Pericardial reflections 





Left atrium 


Right pulmonary vein 



Left superior 

pulmonary vein 

Left atrium 

98 99 

Left inferior 

pulmonary 

vein 

Right atrium 

Right 

pulmonary veins 

Sulcus terminalis 



Posterior view of the heart. 

Volume-rendered posterior view using 

multidetector computed tomography 

Right atrium 


Apex 



Coronary sinus 




Base of the heart 



100 

Circumflex branch of 

left coronary artery 



Left atrium 


Right atrium 





Diaphragmatic surface of the heart 

Apex 

Posterior interventricular 

branch of right coronary artery 

(right posterior descending) 

Posterior interventricular sulcus 

(containing vessels) 


Middle cardiac vein 

95

THORAX • 

Right atrium 


101 

Right auricle 


Limbus of fossa ovalis 

Tricuspid valve 


Crista terminalis 

Musculi pectinati 

Fossa ovalis 


Valve of inferior vena cava 

Opening of coronary sinus 

Valve of coronary sinus 

Internal view of right atrium 

102 


Right atrium 


Left atrium 

96 

Positioning of right atrium in relation to other cardiac chambers. 

CT image, with contrast, in axial plane


3 



103 


Right auricle 


Left auricle 

Right atrium 

Anterior semilunar cusp 

Right semilunar cusp 

Left semilunar cusp 

Pulmonary 

valve 

Conus arteriosus 

Tricuspid 

valve 

Anterior cusp 

Septal cusp 

Posterior cusp 

Septal papillary muscle 

Trabeculae carneae 

Septomarginal trabecula 

Chordae tendineae 


Anterior papillary muscle 

Posterior papillary muscle 

Internal view of right ventricle 

104 


Right atrium 


Left atrium 

Positioning of right ventricle in relation to other cardiac chambers. 


97

THORAX • 

Left atrium 


105 

Left auricle 


Pulmonary arteries 



Valve of foramen ovale 

Left atrium 

Mitral valve 


Internal view of left atrium 

106 


Right atrium 


Left atrium 

98 

Positioning of left atrium in relation to other cardiac chambers. 

CT image, with contrast, in axial plane


3 


107 


Mitral valve posterior cusp 

Left auricle 


Mitral valve anterior cusp 

Pulmonary arteries 

Chordae tendineae 

Anterior interventricular vessels 



Left atrium 

Trabeculae carneae 




Internal view of left ventricle 

108 


Right atrium 


Left atrium 

Positioning of left ventricle in relation to other cardiac chambers. 


99

THORAX • 

Aortic valve and cardiac skeleton 


Right 

coronary 

artery 

Opening for right 

coronary artery 

Aortic sinus 

Nodule 

Opening for left 


Aortic sinus 

Left coronary artery 

Lunule 

Nodule 

Posterior semilunar cusp 

Lunule 

Nodule 

Aortic sinus 

09 



Right semilunar cusp 

Posterior semilunar cusp 

Anterior view of the aortic valve 

(resected and opened out) 

Left semilunar cusp 

Lateral view of the 

aortic valve in diastole 

Superior view of the 

aortic valve in systole 

110 111 

Anterior 

Fibrous ring of pulmonary valve 



Left fibrous trigone 

Left 

Anterior cusp of mitral valve 

Right 

Fibrous ring of aortic valve 

Anterior cusp of tricuspid valve 

Left atrioventricular ring 

Atrioventricular bundle 


Posterior cusp of mitral valve 

Right atrioventricular ring 


Posterior cusp of tricuspid valve 

Right fibrous trigone 

Posterior 

Cardiac skeleton (superior view; 

atria removed) 

Septal cusp of tricuspid valve 

112 

100

Cardiac chambers and heart valves 

3 














Pulmonary valve 

Deoxygenated blood 

113 

Deoxygenated blood 





Rt 

Ant 


Lt 

Left auricle 

Lt 

Oxygenated blood 


Rt 

Aortic valve 

Post 

Ant 

Mitral valve 

Oxygenated blood 

Post 


sulcus 

Ant 

Right atrium 

Septal 



Post 

Obtuse margin 




Apex 


Inferior margin 

Cardiac chambers and direction of blood flow 

101

THORAX • 

Coronary vessels 

114 



Circumflex branch 





Anterior cardiac veins 




Anterior interventricular vein 


Marginal vessels 

116 


Left atrium 

Cardiac vasculature (anterior view) 


Oblique vein of 

left atrium 



of left coronary 

artery 

Posterior 

cardiac vein 


Right coronary 

artery 

115 



Posterolateral branch 

of circumflex 



Right atrium 

Posterior view of the heart showing the coronary sinus 

Volume-rendered posterior view using multidetector computed tomography 

Posteroinferior view 


branch of right coronary 

artery (right 

posterior descending) 

Middle cardiac vein 

102

Coronary arteries and variations 

3 


117 


Sinu-atrial nodal branch 

of right coronary artery 

Left auricle 




Right atrium 


Left marginal branch 



branch of left 



Diagonal branch of 

anterior interventricular 

Marginal branch 



branch of right coronary artery 

Coronary arteries (right dominant system) 


Posterolateral branches 




Left coronary 

artery 



Right marginal branch 


Posterior interventricular branch 


Coronary angiography (right dominant system). 

Left anterior oblique projection, cranial angulation, of right coronary artery 

Interventricular septal branch 

of anterior interventricular 

Diagonal branches of 




Coronary angiography (right dominant system). 

Left anterior oblique projection, cranial angulation, of left coronary artery 

118 119 

103

THORAX • 

Coronary arteries and variations 

120 


Sinu-atrial nodal branch 



Left auricle 




Right atrium 





branch of left 



Diagonal branch of 


Marginal branch 


Posterior interventricular branch of 

circumflex 

Coronary arteries (left dominant system) 




Left coronary 

artery 



121 

122 

Diagonal branches 

of anterior 

interventricular 

Coronary angiography (left dominant system). 

Left anterior oblique projection, cranial angulation, of right coronary artery 

104 

Right marginal branch 



branch of circumflex 

Posterolateral branch 




Coronary angiography (left dominant system). 

Left anterior oblique projection, cranial angulation, of left coronary artery

Cardiac conduction system 

3 

Aorta 



Conduction system of the heart 

Sinu-atrial node 

Right bundle branch 

Atrioventricular bundle 

Atrioventricular node 

Septomarginal trabecula 


Right chambers 

123 



Aorta 

124 

Left bundle branch 




Left atrium 




Left chambers 

105

THORAX • 

Auscultation points and heart sounds 

Auscultation position 

for aortic valve 


for pulmonary valve 

II 

Aortic valve 

III 

Pulmonary valve 


V 

Mitral valve 

VI 


for tricuspid valve 


for mitral valve 

Auscultation points 

125 

Closure of mitral and tricuspid valves 

Closure of aortic and pulmonary valves 

Ventricular pressure 

R 

126 

P 

T 

ECG 

Q 

S 

1st 2nd 1st 

Heart sounds 

"lubb" 

"dubb" 

"lubb" 

SYSTOLE 

DIASTOLE 

SYSTOLE 

Cardiac auscultation 

106

Cardiac innervation 

3 

Trachea 

Right sympathetic trunk 











Thoracic cardiac branch of vagus nerve 


Thoracic (sympathetic) cardiac branches 

Deep cardiac plexus 

Right superior lobar bronchus 

Third thoracic sympathetic ganglion 

Thoracic (sympathetic) cardiac branches 

Thoracic cardiac branch of vagus nerve 


Superficial cardiac plexus 







Left superior lobar bronchus 



127 


Esophagus 


Cardiac plexus and nerves of the heart 

107

THORAX • 

Superior mediastinum: thymus 

Esophagus 




Trachea 







Sternal angle 










128 

Surface projections of structures in the superior mediastinum 




Esophagus 

Trachea 






Right pericardiacophrenic artery 

Left pericardiacophrenic artery 


Right internal thoracic artery 


Thymus gland 




Left internal thoracic artery 



Cut edge of mediastinal pleura 


129 

Thymus gland 

108

Superior mediastinum: veins and arteries 

3 




Esophagus 

Trachea 






Inferior thyroid vein 

Right internal thoracic vein 

Left internal thoracic vein 

Left pericardiacophrenic vein 


Right pericardiacophrenic vein 








Pericardium 



130 

Veins of the superior mediastinum 






Left pulmonary vein 


131 

Anterior view of the superior mediastinum showing venous and arterial channels. 


109

THORAX • 

Superior mediastinum: arteries and nerves 

Trachea 










Cardiac branch 

of vagus nerve 

Cardiac branches 

(sympathetic) 





(sympathetic) 




Left recurrent 

laryngeal nerve 









Pericardium 

132 

Arteries and nerves of the superior mediastinum 

110

Superior mediastinum: imaging 

3 






Right atrium 


133 

Positioning of venous channels in the superior mediastinum. 










134 


Anterior view of the superior mediastinum with the venous 

channels, pulmonary trunk, and heart removed. 


111

THORAX • 

Superior mediastinum: veins and trachea 




Trachea 








Right brachiocephalic 

vein 




Ligamentum 

arteriosum 






Hilum in 




Hilum in 


Esophagus 





135 

Trachea and structures relating to it in the superior mediastinum 

112

Mediastinum: imaging 

3 






Right atrium 

136 

Positioning of brachiocephalic trunk in relation to other structures in the superior mediastinum. 






137 


Positioning of left common carotid artery in relation to other structures in the superior mediastinum. 



Trachea 





138 

Positioning of left subclavian artery and the bifurcation of the trachea in relation 

to other structures in the superior mediastinum. 


113

THORAX • 

Mediastinum: view from right 

Trachea 

Esophagus 





Bronchus 

Azygos vein 

Tracheobronchial 

lymph nodes 

Esophageal plexus 



Rib I 



Clavicle 

Right subclavius muscle 





Thymus gland 


Pericardiacophrenic artery 

and vein 




Pericardium 


Greater splanchnic nerve 

139 

Cut edge of costal pleura 

Diaphragm covered by 

diaphragmatic pleura 

Right side of mediastinum and right thoracic cavity 

114

Mediastinum: imaging – view from right 

3 


Esophagus 

Trachea 

Left brachiocephalic 

vein 



Right pulmonary 

artery 

Right pulmonary 

veins 

140 

View of mediastinal structures from the right side of the thorax. 

Volume-rendered lateral view from the right side using multidetector computed tomography 

115

THORAX • 

Mediastinum: view from left 

Trachea 

Esophagus 

Clavicle 

Subclavius 





Thymus gland 





Pericardium 




Left superior intercostal vein 




Bronchus 


Left phrenic nerve and 








Cut edge of costal pleura 

Diaphragm covered by 

diaphragmatic pleura 

141 

Left side of mediastinum and left thoracic cavity 

116

Mediastinum: imaging – view from left 

3 


Esophagus 

Left common 

carotid artery 




Left pulmonary 

artery 

142 


Cut edge of diaphragm 


View of mediastinal structures from the left side of the thorax. 

Volume-rendered lateral view from the left side using multidetector computed tomography 

117

THORAX • 



Right supreme intercostal artery 

Trachea 

Esophagus 



Right third posterior 


Posterior intercostal vein 

Left supreme intercostal artery 

(from left costocervical trunk) 




Posterior 

intercostal 

arteries 

Right main 

bronchus 

Posterior 

vagal trunk 

Intercostal 

nerve 





Mediastinal branches 

of aorta 

Anterior vagal trunk 

Esophageal branches 

of aorta 


Stomach 

143 

Trachea 

Right third posterior 


Right bronchial 

artery 

Diaphragm 

Structures of the posterior mediastinum 



Superior left 

bronchial artery 

Inferior left bronchial artery 

144 


118 




(posterior view)


3 




Esophagus 



Thoracic duct 







Azygos vein 

Accessory 




veins 

Thoracic duct 


Greater splanchnic 

nerve 

Lesser splanchnic 

nerve 

Least splanchnic nerve 

Right subcostal vein 

Diaphragm (cut) 



Lesser splanchnic nerve 


Left crus of diaphragm 

Ascending lumbar vein 


Right crus of diaphragm 

145 

Structures of the posterior mediastinum 

(thoracic aorta and esophagus removed) 

119

THORAX • 


146 





Trachea 



Esophagus 

A 

147 


Trachea 





Esophagus 

B 

A through I – This is a series of images that pass through the thorax from superior to inferior 

showing the various mediastinal structures and their relationships with each other. 


Thymus 



148 



Brachiocephalic artery 

Trachea 


Esophagus 

Right lung 

TIII 






Thoracic duct 

Left lung 

Transverse section through the superior mediastinum at the level of vertebra TIII 

120


3 

149 


Trachea 




Esophagus 

C 

150 



Trachea 

Esophagus 

Azygos vein 

D 

151 


Thymus 



Arch of azygos vein 


Trachea 

Esophagus 

Right lung 

TIV 





Thoracic duct 

Left lung 

Transverse section through the superior mediastinum at the level of vertebra TIV 

121

THORAX • 


152 








Esophagus 

Carina 


E 

153 






Esophagus 




F 


154 







Azygos vein 

Right lung 

TV 

Left lung 






Esophagus 

Thoracic duct 


Transverse section through the superior mediastinum at the level of vertebra TV 

122


3 


155 

Right atrium 




Left atrium 


G 

156 


Right atrium 


Left atrium 


Esophagus 

H 

Liver 

157 



Esophagus 


I 

A through I – This is a series of images that pass through the thorax from superior to inferior 

showing the various mediastinal structures and their relationships with each other. 


123

THORAX • 

Transverse section: TVIII level 



Right atrium 


Fibrous pericardium and parietal layer 

of serous pericardium 

Right internal thoracic vessels 

Visceral layer of serous pericardium 

(epicardium) 

Sternum 



Interventricular septum 


Mitral valve 

Left atrium 

158 

Left phrenic nerve and 

pericardiacophrenic vessels 


Left pulmonary 

vein 

Branches of right main 

bronchus 

Right lung 

Esophagus 

Azygos vein 

Thoracic duct 





Left lung 

Branches of left main 

bronchus 



Transverse section through thorax 

(approximately TVII) 

124


3 

Medial supraclavicular nerve 

C3 

Intermediate supraclavicular nerve 

Lateral supraclavicular nerve 

C4 

T2 

T3 

159 

T4 

T5 

T6 

Costal margin 

T7 

T8 

T9 

Lateral cutaneous nerves 

T3–T11 

T10 

T11 

Anterior cutaneous branches 

of intercostal nerves T2–T11 


of subcostal nerve T12 

T12 


of subcostal nerve T12 

Dermatomes and cutaneous nerves of the thoracic region 

125

THORAX • 

Visceral efferent (motor) innervation of the heart 

Dorsal motor nucleus of vagus nerve 

160 





Medulla 

Vagus nerves 

Cervical and thoracic 

cardiac branches of vagus 

Cervical 

spinal cord 

Cervical sympathetic 

ganglion 

T1–T4 

spinal cord levels 

Cardiac plexus 

Cervical and thoracic 

cardiac nerves 

White ramus 

communicans 

Visceral efferent (motor) innervation of the heart 

(sympathetic and parasympathetic) 

126

Visceral afferents 

3 

161 

Nuclei of solitary tract 

Visceral afferent (following sympathetics) 

Visceral afferent (following parasympathetics) 

Somatic afferent 

Inferior vagal 

ganglion 

Medulla 

Visceral afferents from chemo- and 

baroreceptors in the aortic arch follow 

parasympathetics of CN X back to brain 

Cervical 

spinal cord 


T1–T4 


Visceral afferent fiber 

“pain” 

Visceral afferents (pain) follow sympathetics 

back to T1–T4 spinal levels. 

Pain is referred by CNS to somatic regions 

innervated by same spinal cord levels 

T2 

T3 

T4 

Somatic afferent fiber 

T1 

T1 

Visceral afferents from heart 

127

THORAX • 

Tables 

Muscles of the pectoral region 


Pectoralis 

major 

1 

Medial half of clavicle and 

anterior surface of sternum, 

first seven costal cartilages, 

aponeurosis of external 

oblique 

Lateral lip of intertubercular 

sulcus of humerus 

Medial and lateral 

pectoral nerves 

Adduction, medial rotation, 

and flexion of the humerus at 

the shoulder joint 

Subclavius 

2 

Rib I at junction between rib 

and costal cartilage 

Groove on inferior surface of 

middle third of clavicle 

Nerve to subclavius 

Pulls clavicle medially to 

stabilize sternoclavicular joint; 

depresses tip of shoulder 

Pectoralis 

minor 

3 

Anterior surfaces of the third, 

fourth, and fifth ribs, and deep 

fascia overlying the related 

intercostal spaces 

Coracoid process of scapula 


nerves 

Depresses tip of shoulder; 

protracts scapula 

Muscles of the thoracic wall 

External 

intercostal 

4 Inferior margin of rib above Superior margin of rib below Intercostal nerves; Most active during inspiration; 

T1–T11 

supports intercostal space; 

moves ribs superiorly 

Internal 

intercostal 

5 Lateral edge of costal groove 

of rib above 

Superior margin of rib below 

deep to the attachment of the 

related external intercostal 

Intercostal nerves; 

T1–T11 

Most active during expiration; 

supports intercostal space; 

moves ribs inferiorly 

Innermost 

intercostal 

6 Medial edge of costal groove 

of rib above 

Internal aspect of superior 

margin of rib below 

Intercostal nerves; 

T1–T11 

Acts with internal intercostal 

muscles 

Subcostales 

7 Internal surface (near angle) 

of lower ribs 

Internal surface of second or 

third rib below 

Related intercostal 

nerves 

May depress ribs 

Transversus 

thoracis 

8 Inferior margins and internal 

surfaces of costal cartilages 

of second to sixth ribs 

Inferior aspect of deep 

surface of body of sternum, 

xiphoid process, and costal 

cartilages ribs IV–VII 

Related intercostal 

nerves 

Depresses costal cartilages 

128

Tables 

3 

2 

1 

3 

4 5 6 

8 

7 

129

THORAX • 

Tables 

Branches of the thoracic aorta 

Branches 

Pericardial branches 

Bronchial branches 


Mediastinal branches 


Superior phrenic arteries 

Subcostal artery 

Origin and course 

1 A few small vessels to the posterior surface of the pericardial sac 

2 Vary in number, size, and origin—usually, two left bronchial arteries from the thoracic aorta and one 

right bronchial artery from the third posterior intercostal artery or the superior left bronchial artery 

3 Four or five vessels from the anterior aspect of the thoracic aorta, which form a continuous anastomotic 

chain—anastomotic connections include esophageal branches of the inferior thyroid artery superiorly, 

and esophageal branches of the left inferior phrenic and the left gastric arteries inferiorly 

4 Several small branches supplying lymph nodes, vessels, nerves, and areolar tissue in the posterior 

mediastinum 

5 Usually nine pairs of vessels branching from the posterior surface of the thoracic aorta—usually supply 

lower nine intercostal spaces (first two spaces are supplied by the supreme intercostal artery—a branch 

of the costocervical trunk) 

6 Small vessels from the lower part of the thoracic aorta supplying the posterior part of the superior 

surface of the diaphragm—they anastomose with the musculophrenic and pericardiacophrenic arteries 

7 The lowest pair of branches from the thoracic aorta located inferior to rib XII 

130

Tables 

3 

2 

5 

4 

3 

1 

7 

6 

131



4 

CONTENTS 

ABDOMEN 


Quadrants and regions 135 

Abdominal wall 136 

Muscles 138 

Muscles: rectus sheath 141 

Vessels of the abdominal wall 142 

Arteries and lymphatics of the abdominal wall 143 

Nerves of the abdominal wall 144 


Inguinal region 146 

Inguinal canal 148 

Inguinal hernias 150 

Anterior abdominal wall 151 

Greater omentum 152 

Abdominal viscera 153 

Peritoneal cavity 154 

Abdominal sagittal section 155 

Abdominal coronal section 156 

Arterial supply of viscera 157 

Stomach 158 

Spleen 159 

Arteries of stomach and spleen 160 

Duodenum 162 

Small intestine 164 

Large intestine 166 

Ileocecal junction 168 

Gastrointestinal tract: imaging 169 

Mesenteric arteries 170 

Liver 172 

Vessels of the liver 174 

Segments of the liver 175 

Pancreas and gallbladder 176 

Vasculature of pancreas and duodenum 179 

Venous drainage of viscera 180 

Portosystemic anastomoses 182 

Posterior wall 183 

Vessels of the posterior wall 184 

Diaphragm 185 

Kidneys 186 

Gross structure of kidneys 188 

Kidneys: imaging 189 

Renal vasculature 190 

Branches of the abdominal aorta 192 

Inferior vena cava 193 

Abdominal aorta and inferior vena cava: imaging 194 

Lumbar plexus 196 

Lumbar plexus: cutaneous distribution 197 


Abdominal innervation 199 

Splanchnic nerves 200 

Visceral efferent (motor) innervation diagram 201 

Visceral afferent (sensory) innervation and 

referred pain diagram 202 

Kidney and ureter visceral afferent 

(sensory) diagram 204 

Tables 206 


ABDOMEN • Surface anatomy 



Costal margin 

Position of linea alba 

Umbilicus 

Position of a tendinous 

intersection of rectus 

abdominis muscle 

Position of a semilunar line 

Iliac crest 

Anterior superior iliac spine 

Position of 

inguinal ligament 


Pubic tubercle 

Anterior abdominal wall surface anatomy 

134 


Quadrants and regions 

4 

Sagittal plane 

Diaphragm 

Liver 

Spleen 

Stomach 

Gallbladder 

Right upper 

Left upper 

Transumbilical plane 

Ascending colon 

Right lower 

Left lower 

Descending colon 


Inguinal ligament 

Sigmoid colon 


Abdominal quadrants and the positions of major viscera 

Midclavicular planes 

Epigastric region 

-referred pain from foregut 

Right 

hypochondrium 

Left 

hypochondrium 

Subcostal plane 

Umbilical region 

-referred pain from midgut 

Right flank 

Left flank 

Intertubercular plane 

Right groin 

Left groin 

Pubic region 

-referred pain from hindgut 

The nine regions of the abdomen 

135 


ABDOMEN • Abdominal wall 

Anterior wall of rectus sheath 

Linea alba 

Superficial 

fascia 


Fatty layer 

(Camper’s) 

Membranous layer 

(Scarpa’s) 

Posterior wall of 

rectus sheath 





Arcuate line 

Extraperitoneal fascia 

Parietal peritoneum 

Layers of the abdominal wall 

136 


Abdominal wall 

4 

Aponeurosis of transversus abdominis 


Linea alba 


Aponeurosis of internal oblique 

Aponeurosis of external oblique 




Skin 

Fatty layer 

(Camper’s) 

Membranous layer 

(Scarpa’s) 

Superficial 

fascia 

Gut tube 

Peritoneal cavity 

Mesentery 


Visceral peritoneum 

Extraperitoneal 

fascia 



Psoas major 





Transverse section showing the layers of the abdominal wall 

(above umbilicus) 

Linea alba 


Aponeurosis of external 

oblique 




Aponeurosis of internal 

oblique 

Aponeurosis of transversus 

abdominis 

Layers of the abdominal wall. 


137 


ABDOMEN • Muscles 


Abdominal part of 

pectoralis major 


Linea alba 


External oblique (cut) 

Umbilicus 



oblique 


oblique 



Superficial inguinal ring 

Lateral crus 

Spermatic cord 

Conjoint tendon 

Cremasteric muscle 

External and internal oblique muscles 

138

Muscles 

4 






Right costal margin 

Linea alba 


Anterior wall of 

rectus sheath 

Umbilicus 






oblique 


abdominis 







Internal oblique and transversus abdominis muscles 

139

ABDOMEN • Muscles 


Costal margin 

Rib X 



Tendinous intersection 



oblique 


Semilunar line 


rectus sheath 


oblique 

Arcuate line 




Pyramidalis 


Linea alba 



Rectus abdominis and pyramidalis muscles 

140

Muscles: rectus sheath 

4 

A 

B 

Organization of the rectus sheath. 

A. Transverse section through the upper three quarters of the rectus sheath 

B. Transverse section through the lower one quarter of the rectus sheath 

Skin 

Superficial fascia (fatty layer) 

Superficial fascia (membranous layer) 



oblique 

Linea alba 





A 



oblique 


abdominis 

Skin 

Superficial fascia (fatty layer) 

Superficial fascia (membranous layer) 



oblique 

Falciform ligament 

Linea alba 








Right medial umbilical ligament 


B 


oblique 


abdominis 

Median umbilical 

ligament 

Inferior epigastric vessels 



Left lateral umbilical fold 

141

ABDOMEN • Vessels of the abdominal wall 

Internal thoracic 


Intercostal vessels 

Lateral thoracic vein 


Superior epigastric artery 

Superior epigastric veins 

Thoraco-epigastric vein 






Deep circumflex iliac 


Superficial circumflex iliac 


Inferior epigastric artery and vein 

Superficial epigastric 



Superficial external pudendal 


Femoral artery and vein 

Vasculature of the anterior abdominal wall 

142

Arteries and lymphatics of the abdominal wall 

4 


Intercostal arteries 




External iliac artery 

Deep circumflex iliac artery 

Inferior epigastric artery 

Superficial circumflex 

iliac artery 


Superficial epigastric artery 

Superficial external 

pudendal artery 


Arteries of the anterior abdominal wall 

Axillary lymph nodes 

Superficial inguinal lymph nodes 

Superficial lymphatic drainage of the 

anterolateral abdominal wall 

143

ABDOMEN • Nerves of the abdominal wall 


Lateral cutaneous branches 




T10 nerve 

Rectus abdominis (cut) 

Anterior cutaneous 

branch of T10 




Subcostal nerve (T12) 

Lateral cutaneous branch of 

iliohypogastric nerve (L1) 

Iliohypogastric nerve (L1) 


Ilio-inguinal nerve (L1) 



Nerves of the anterolateral abdominal wall 

144


4 

T2 

T3 

T4 

T5 

T6 

Costal margin 

T7 

T8 

T9 

Lateral cutaneous nerves 

T7–T11 

T10 

T11 

Anterior cutaneous branches 




T12 




L1 


of iliohypogastric nerve (L1) 

Dermatomes and cutaneous nerves of the anterolateral abdominal wall 

145

ABDOMEN • Inguinal region 



Inguinal canal 



Deep inguinal ring 

(in transversalis fascia) 


(in aponeurosis of external oblique) 

Position of pubic symphysis 


Inguinal region in a man 



(in transversalis fascia) 


(in aponeurosis of external oblique) 

Position of pubic symphysis 





Round ligament of uterus 

Inguinal region in a woman 

146

Inguinal region 

4 


Left renal vein 

Right testicular vein 


Right testicular artery 



Left ovarian vein 

Left ureter 

Left ovarian artery 


Transversus 

abdominis (cut) 



Genital branch of 

genitofemoral nerve 



Rectum 

Right inferior epigastric 


Location of 

deep inguinal ring 

Ductus deferens 


Uterus 

Sigmoid colon 

Uterine tube 

Ovary 


Peritoneum (cut) 


and vein 

Iliacus 

Psoas major 

Location of superficial 

inguinal ring 


Epididymis 





Location of superficial 

inguinal ring 

Testis 

Bladder 

Penis in section 

Inguinal region in men 

Inguinal region in women 

147

ABDOMEN • Inguinal canal 


Femoral branch of genitofemoral nerve 

Testicular artery and veins 

Genital branch of genitofemoral nerve 

External iliac artery and vein 

Right inferior epigastric artery and vein 



Transversus abdominis (cut) 




Pubic vessels 


Bladder 

Cremasteric vessels 

Location of deep inguinal ring 





Lacunar ligament 



Aponeurosis of 

external oblique 



Inguinal canal and spermatic cord 

148


4 



Left inferior epigastric artery and vein 


Lateral umbilical fold 


Medial umbilical ligament 

(obliterated umbilical artery) 

Median umbilical ligament (urachus) 





oblique (cut) 

Deep circumflex iliac vessels 



Testicular artery and pampiniform plexus of veins 

External spermatic fascia 

(from aponeurosis of external oblique) 


(from internal oblique muscle) 

Pyramidalis (cut) 

Rectus abdominis (cut) 

Internal spermatic fascia 

(from transversalis fascia) 


Parietal layer of tunica vaginalis 

Head of epididymis 

Visceral layer of tunica vaginalis 

Inguinal canal and structures of the spermatic cord 

149

ABDOMEN • Inguinal hernias 












Peritoneal bulge 

Medial 

Lateral 


Peritoneal sac 

Medial 

Lateral 

Testis 

Indirect inguinal hernia 

Direct inguinal hernia 

Lateral umbilical fold 


Direct hernia 



Testicular vessels 

External iliac vessels 

Right inguinal triangle. 

Laparoscopic view showing the parietal peritoneum still covering the area 

(inside the peritoneal cavity looking anteroinferior) 

150

Anterior abdominal wall 

4 


diaphragm 



Cut edge of external 

oblique 

Cut edge of internal 

oblique 

Cut edge of transversus 

abdominis 


transversalis fascia 


parietal peritoneum 

Left lateral 

umbilical fold 

Iliacus 

Psoas major 



Bladder 


Levator ani 

Ischio-anal fossa 

Deep perineal pouch 

Perineal membrane 

Prostate gland 



Obturator membrane 


Femoral vein 

Inguinal triangle 

(Hesselbach’s triangle) 

Round ligament 

of the liver 

(ligamentum teres) 


rectus sheath 


transversalis fascia 

Umbilicus 

Transversus 

abdominis 

Right medial 

umbilical ligament 

Median umbilical 

fold 

Arcuate line 

Right inferior epigastric 




Right testicular vessels 



Internal view of anterior abdominal wall in men 

151

ABDOMEN • Greater omentum 



Diaphragm 


Left lobe of liver 

Right lobe of liver 

Stomach 

Gallbladder 






Greater omentum 




Iliacus 

Bladder 

Psoas major 

Femoral 

vein and artery 


152


4 




Spleen 


Gallbladder 

Stomach 


of liver 






Right paracolic gutter 


Transversus 


Left paracolic gutter 


Cecum 


Iliacus 

Bladder 

Psoas major 

Obturator canal 


Abdominal viscera (greater omentum removed) 

153

ABDOMEN • Peritoneal cavity 

Subphrenic recess 

Diaphragm 

Liver 

Lesser omentum 


Lesser sac (omental bursa) 

Pancreas 

Stomach 

Greater sac 

Transverse mesocolon 


Duodenum 



Rectus sheath 

Mesentery 




Greater sac 

Bladder 

Rectum 


Greater and lesser sacs of the peritoneal cavity 

154

Abdominal sagittal section 

4 

Heart 

Liver 

Pancreas 

Stomach 


Celiac trunk 





Rectum 

Bladder 

Liver 

Pancreas 

Stomach 

Omental bursa 

Portal vein 




Mesentery 


Rectum 

Bladder 

Arrangement of abdominal contents in peritoneal cavity. 

CT images, with contrast, in sagittal plane 

155

ABDOMEN • Abdominal coronal section 

Diaphragm 

Hepatic vein 

Liver 

Hepatic duct 

Hepatic artery proper 

Portal vein 

Gallbladder 

Stomach 

Spleen 

Pyloric antrum 



Duodenum 


Head of pancreas 

Superior mesenteric 


Jejunum 

Ileocolic artery 

Ileocolic vein 

Ileocecal junction 

Cecum 

Mesentery 

Iliac crest 

Appendix 

Ileum 

Bladder 

Sigmoid colon 

Coronal section 

Liver 

Gallbladder 

Pancreas 


vein 

Duodenum 



Stomach 

Pancreas 

Spleen 


artery 


Iliac crest 

Bladder 

156 

Coronal section. 

CT image, with contrast, in coronal plane

Arterial supply of viscera 

4 


Short gastric arteries 

Left hepatic artery 

Right hepatic artery 

Esophageal artery 

Spleen 

Cystic artery 



Right gastric artery 

Gastroduodenal artery 

Supraduodenal artery 

Left gastric artery 

Celiac trunk 

Left gastro-omental artery 

Stomach 

Duodenum 

Posterior pancreaticoduodenal artery 


Anterior pancreaticoduodenal artery 

Inferior pancreaticoduodenal artery 

Right gastro-omental artery 


Marginal artery 


Middle colic artery 

Right colic artery 




Left colic artery 




Sigmoid arteries 

Appendicular artery 

Appendix 

Rectum 

Sigmoid colon 

Superior rectal artery 

157

ABDOMEN • Stomach 

Abdominal esophagus 

Internal and external features 

of the stomach 

Fundus 

Junction of gastric and 

esophageal mucosa 

Cardial notch 

Cardiac orifice 

Pyloric orifice 

Gastric folds (rugae) 

Gastric canal 

Pylorus 

Cardia 

Lesser curvature 

Body 

Angular incisure 

Duodenum 

Greater 

curvature 

Liver Stomach Spleen 

Pyloric canal 


Superior part of duodenum 


Esophagus 

Fundus of 

stomach 



Diaphragm 

Positioning of the stomach. 



stomach 

Descending part of duodenum 

Duodenojejunal junction 

158 

Surface projection of the stomach 

Stomach. Double-contrast radiograph using barium

Spleen 

4 

Rib IX 

Spleen 

Rib XI 

Diaphragm 


Stomach 


Left kidney 


Spleen 



Surface projection of the spleen (posterior view) 

Superior pole 

Gastric impression 

Rectus abdominis muscle 


Lateral view of abdominal 

cavity with spleen 

Hilum 

Renal 

impression 


Short gastric vessels 

Splenorenal ligament 


Splenic vein 

Left gastro-omental 


Liver 

Abdominal 

aorta 

Inferior 

vena cava 

Right kidney 

Stomach 

Pancreas 

Spleen 

Splenic 

vein 

Left 

kidney 

Colic impression 

Inferior pole 

Surfaces and hilum of the spleen 

Location of the spleen. 


159

ABDOMEN • Arteries of stomach and spleen 

Hepatic veins 



Diaphragm 



Celiac trunk 

Right suprarenal gland 




Stomach 



pancreaticoduodenal 

artery 

Duodenum 



artery 

Right kidney 

Anterior inferior 


artery 

Superior 

mesenteric vein 

Right ureter 

Spleen 




Left kidney 

Right gastro-omental 

artery 

Posterior inferior 


artery 

Left ureter 

Inferior 

mesenteric artery 

Superior 


Distribution of the celiac trunk 


Celiac trunk 






pancreaticoduodenal artery 

Anterior superior pancreaticoduodenal artery 

Stomach 

Inferior pancreaticoduodenal artery 



Anterior inferior pancreaticoduodenal artery 


Branches of the gastroduodenal artery 



160

Arteries of stomach and spleen 

4 






Cystic artery 




Digital subtraction angiography of the celiac trunk and its branches 

Liver 

Celiac trunk 

Pancreas 

Stomach 

Spleen 

Portal vein 

Splenic vein 

Pancreas 

Superior 

mesenteric 

artery 

Right 

kidney 

Inferior 

vena cava 


Left kidney 

Liver 

Celiac trunk 


Spleen 

Positioning of the celiac trunk in relation to other structures. 


Branching of the celiac trunk from the abdominal aorta. 


161

ABDOMEN • Duodenum 


Esophagus 

Celiac trunk 

Left suprarenal gland 

Neck of pancreas 

Portal vein 


Duodenum 

–superior part 

Right kidney 

Transverse colon (cut) 


Duodenum 

–descending part 


Duodenum 

–inferior part 



Transverse colon (cut) 

Body of pancreas 

Left kidney 

Superior 


Duodenum 

–ascending part 


Testicular (ovarian) 



Left ureter 

Duodenum in situ 

Duodenal cap 

Pyloric sphincter of stomach 

Duodenum 


Pyloric antrum of stomach 

Duodenum 


Pyloric canal 

Duodenum 


Double-contrast radiograph showing the duodenal cap 

162

Duodenum 

4 

Hepatic artery proper Gastroduodenal artery 

Common hepatic duct 


Bile duct 

Cystic duct 

Superior part 

(first part) 

Portal vein 


Gallbladder 

Splenic artery and vein 


Suspensory muscle (ligament) 

of duodenum 

(ligament of Treitz) 

Duodenojejunal flexure 

Right kidney 

Descending part 

(second part) 

Minor duodenal papilla 


vein and artery 

Ascending part 

(fourth part) 

Major duodenal papilla 


Inferior part 

(third part) 


Parts of the duodenum and related structures 

Liver 

Pancreas 

Stomach 

Duodenum 

–superior and descending parts 

Pancreas 


vein 

Splenic vein 

Spleen 


Duodenum 


Relationship of duodenum to structures in the vicinity. 


163

ABDOMEN • Small intestine 

Inferior border of liver 


Round ligament of liver 


Cardial notch 

Gallbladder 




(hepatoduodenal 

ligament) 

Omental foramen 


(hepatogastric ligament) 

Spleen 

Stomach 

Duodenum 


Middle colic artery (cut) 

Jejunum 

Superior 





Mesentery 



Taenia coli 

Appendix 

Jejunal and ileal 

arteries and veins 

Iliacus 

Psoas major 

Ileum 

164 

Small intestine displaced to show superior mesenteric vessels


4 

Ileum 

Jejunum 

Vasa recta 

Arterial arcades 

Vasa recta 

Mesentery 

Arterial arcades 

Differences in the arterial supply to the jejunum and ileum 

Mesentery 

Ileum 

Jejunum 

Stomach 

Duodenum 



Jejunum 

Ileocecal 

junction 

Descending 

colon 

Cecum 

Ileum 

Appendix 

Sigmoid colon 

Jejunum and ileum 

Radiograph using barium, showing jejunum and ileum 

165

ABDOMEN • Large intestine 






Semilunar fold 

Omental appendices 

Haustra of colon 

Taenia coli 

Ileum 

Cecum 

Mesoappendix 

Sigmoid colon 

Appendix 

Large intestine (anterior view) 

Rectum 



Anal canal 



Cecum 

Liver 

Spleen 


Sigmoid colon 

Rectum 


Anal canal 

166 

Large intestine (left lateral view) 

Surface projection of the large intestine

Large intestine 

4 






Sigmoid colon 

Rectum 

Radiograph using barium, showing the large intestine 

Liver 



Stomach 

Gallbladder 


Sigmoid colon 

Transverse colon showing right and left colic flexures. 


167

ABDOMEN • Ileocecal junction 


Free taenia 

Ileocecal fold flaps 

Ileum 

Cecum 

Meso-appendix 

Orifice of appendix 

Ileocecal junction 

Appendix 

Ileocecal fold 

Pre-ileal 

Postileal 

Colonoscopy showing ileocecal fold 

Pelvic 

Retrocecal 

Subcecal 

Positions of the appendix 

168

Gastrointestinal tract: imaging 

4 

A 

B 

C 

D E F 

G H I 

F 

E 

J 

D 

A 

I 

B 

C 

G 

H 

Endoscopy and colonoscopy showing 

different parts of the gastrointestinal tract. 

A. Gastroesophageal junction 

B. Cardiac orifice and fundus of stomach-retroflexed view 

C. Body of stomach 

D. Pylorus of stomach and pyloric sphincter 

E. Duodenum 

F. Cecum showing appendiceal opening 

G. Transverse colon 

H. Sigmoid colon 

I. Rectum-retroflexed view 

J. Pectinate line 

J 

169

ABDOMEN • Mesenteric arteries 


Vasa recta 



Middle colic artery 


Superior 


Duodenum 

Inferior 




Left colic artery 


Sigmoid arteries 


Appendix 

Sigmoid colon 

Jejunal and ileal arteries 

Rectum 


Anal canal 

Superior and inferior mesenteric arteries 

Right colic artery Superior mesenteric artery 


Inferior mesenteric 

artery 

Jejunal arteries 

Left colic 

artery 

Catheters 

Sigmoid 

arteries 

Distal small 

arteries 


Ileal arteries 

170 

Digital subtraction angiography of the superior 

mesenteric artery and its branches 

Digital subtraction angiography of the inferior 

mesenteric artery and its branches

Mesenteric arteries 

4 

Liver 

Superior 



Spleen 

Superior 



Right kidney 

Left kidney 

Diaphragm 

Branching of the superior mesenteric artery from the abdominal aorta. 


Liver 

Stomach 

Spleen 




Positioning of the superior mesenteric artery in relation to other structures. 


171

ABDOMEN • Liver 

Gallbladder 

Heart 

Diaphragm 

Liver 

Stomach 

Location of the liver. 


Surface projection of the liver (anterior view) 

Diaphragm 


Coronary ligament 

Right triangular 

ligament 

Left triangular 

ligament 

Right lobe 

Left lobe 



Round ligament of the liver 

(ligamentum teres hepatis) 

Gallbladder 

Anterior surface of liver 

172

Liver 

4 


Posterior coronary ligament 

Anterior coronary ligament 

Left triangular ligament 

Caudate lobe 


Suprarenal impression 

Bare area 

Anterior coronary ligament 

Posterior coronary ligament 

Right triangular ligament 



Renal impression 


Neck 

Esophageal impression 

Fissure for ligamentum venosum 

Body 

Gallbladder 

Porta hepatis 

Fundus 

Round ligament of the liver 

Quadrate lobe 

Posterior surface of liver 

Colic impression 

Hepatic ducts 

Fundus 

Quadrate lobe 

Fissure for ligamentum teres (round ligament) 

Gallbladder 

Body 

Neck 

Porta hepatis 

Cystic duct 



Bile duct 


Portal vein 

Caudate lobe 

Fissure for ligamentum venosum 


Visceral surface of liver 

173

ABDOMEN • Vessels of the liver 

Intermediate hepatic vein 

Right hepatic vein 


Left hepatic vein 

Left branch 

of portal vein 

Right branch 

of portal vein 

Portal triad 

Left branch of hepatic artery proper 


Portal vein 


Right branch of hepatic artery proper 

Anterior surface of liver with hepatic veins, portal vein, and associated vessels 

Liver 

Hepatic veins 

Esophagus 

Stomach 



Intermediate hepatic vein 

Right hepatic vein 

Left hepatic vein 

II 

VII 

VIII 

I 

IV 

III 

VI 

V 

Left and right branches 

of hepatic artery proper 


Gallbladder 

Portal vein 


Bile duct 

Hepatic veins entering the inferior vena cava 

in the substance of the liver. 


Arrangement of the hepatic venous segments 

174

Segments of the liver 

4 

Posterior medial segment VIII 

(Anterior superior area) 

Medial segment IV 

(Medial superior area) 

Posterior lateral segment VII 

(Posterior superior area) 

Lateral segment II 

(Lateral superior area) 

Left anterior lateral segment III 

(Lateral inferior area) 


(Medial inferior area) 

Right anterior lateral segment VI 

(Posterior inferior area) 

Anterior medial segment V 

(Anterior inferior area) 


(Medial inferior area) 

Left anterior lateral segment III 

(Lateral inferior area) 

Posterior lateral segment VII 

(Posterior superior area) 

Lateral segment II 

(Lateral superior area) 

Posterior (caudal) segment I 

Caudate process 

Right caudate lobe 

Left caudate lobe 

Segments of the liver shown on anterior and visceral surfaces 

175

ABDOMEN • Pancreas and gallbladder 

Stomach 


Celiac trunk 

Portal vein 

Gallbladder 

Spleen 


Tail of pancreas 

Body of pancreas 

Right kidney 

Bile duct 

Duodenum 

Head and uncinate 

process of pancreas 

Right ureter 

Left kidney 

Jejunum 


Left ureter 



Pancreas with related structures 

Body 

Neck 

Tail 

Head 

Pancreatic notch 


Anterior surface of the pancreas 

Liver 

Stomach 

Pancreas 

Celiac trunk 

Diaphragm 

Splenic vein 

Tail of pancreas 

Aorta 

Spleen 

Pancreas. 


176

Pancreas and gallbladder 

4 

Fundus 

Gallbladder 

Body 

Right hepatic duct 

Left hepatic duct 

Neck 

Pancreas 


Cystic duct 

Pyloric orifice 

Duodenum 


Accessory pancreatic duct 

Minor duodenal papilla 

Bile duct 

Duodenum 


Main pancreatic duct 


Jejunum 

Major duodenal papilla 

Hepatopancreatic ampulla 

Duodenum 

–ascending part 


Duodenum 


Bile and pancreatic ducts 

Gallbladder 

Liver 

Portal vein 


Spleen 

Pancreas 

Aorta 

Diaphragm 

Positioning of the gallbladder in relation to other structures. 


177

ABDOMEN • Pancreas and gallbladder 

Fundus 



Body 


Gallbladder 


Neck 


Cystic duct 

Spiral valve 


Bile duct 

Duodenum 


Cystic duct 

Bile duct 

Section through gallbladder and bile ducts 

Bile duct system. 

Magnetic resonance cholecystopancreatogram 

Liver 

Pancreas 

Stomach 

Liver 


Pancreas 

Stomach 

Duodenum 


Superior 


Superior 


Spleen 

Right kidney 


Left kidney 

Spleen 

Positioning of the pancreas in relation to other structures. 


Relationship of pancreas to the stomach and spleen. 


178

Vasculature of pancreas and duodenum 

4 

Splenic vessels cut 

(spleen removed) 



Left hepatic 

duct 





Stomach 


Celiac 

trunk 

Portal vein 

Cystic duct 


Left gastro-omental vein 

Splenic vein 


Inferior pancreatic artery 


Dorsal pancreatic artery 


Anterior inferior pancreaticoduodenal artery 

Uncinate process of pancreas 



Bile duct 






Vasculature of the pancreas (posterior view) 




Gallbladder 

Liver 

Cystic artery 

Cystic duct 


Portal vein 



Celiac trunk 



Bile duct 


Splenic vein 


Stomach 






Uncinate process of pancreas 


Distribution of the common hepatic artery 

179

ABDOMEN • Venous drainage of viscera 

Stomach (cut) 

Gallbladder 

Short gastric veins 

Liver (retracted) 

Portal vein 

Right gastric vein 

Pancreas (cut) 

Right gastro-omental vein 

Pancreaticoduodenal vein 

Branch of middle colic vein 

Duodenum 

Right colic vein 


Spleen 

Left gastric vein 

Splenic vein 




Left gonadal vein 



Left colic veins 




Jejunal and ileal veins 

Ureter 

Sigmoid veins 

Cecum 

Appendix 

Sigmoid colon 

180 

Venous drainage of the abdominal portion of the gastrointestinal tract in situ

Venous drainage of viscera 

4 


Right gastric vein 

Short gastric veins 

Splenic vein 

Portal vein 

Right gastro-omental vein 


Pancreaticoduodenal vein 





Right colic vein 

Left colic veins 


Jejunal and ileal veins 

Superior rectal vein 

Sigmoid veins 

Venous drainage of the abdominal portion of the gastrointestinal tract 

Liver 

Portal vein 


Pancreas 

Duodenum 


Stomach 

Pancreas 

Splenic vein 


(enters superior mesenteric vein 

just anterior to this view) 

Spleen 


Formation of the portal vein. 


181

ABDOMEN • Portosystemic anastomoses 

Para-umbilical veins 

Liver 

Tributaries to azygos vein 


Spleen 

Portal vein 

Stomach 

Splenic vein 

To azygos system 

1 



4 

Esophageal and 

gastric veins 

Superficial veins on 

abdominal wall 



Common iliac vein 

Internal iliac vein 

Middle rectal vein 

External iliac vein 

Internal 

pudendal vein 

Superior rectal vein 

Rectum 

3 

Inferior rectal vein 

Portosystemic anastomoses 

Connecting with 

superficial veins 

5 


1 

2 

3 

4 

5 

Esophageal varices: 

swollen connections between systemic and portal 

systems at inferior end of esophagus 

Varices at the anorectal junction: 


systems at inferior end of rectum and anal canal 

Caput medusae: 


systems around umbilicus 

Swollen connections between systemic and portal 

systems at bare area of liver 

Swollen connections between veins associated with 

retroperitoneal parts of the gastrointestinal tract and 

the body wall 


Internal pudendal vein 

2 


Venous enlargement in portal hypertension (varices) 

182 


Posterior wall 

4 

Caval opening 


Diaphragm 

Median arcuate ligament 

(aortic hiatus) 

Medial arcuate ligament 


Right crus of diaphragm 

Left crus of diaphragm 

Transversus 



Psoas major 


Psoas minor 

Iliacus 


iliac spine 



Muscles of the posterior abdominal wall 

183 


ABDOMEN • Vessels of the posterior wall 

Esophagus 

Aortic hiatus and median arcuate ligament 

Hepatic veins 

Diaphragm 




Superior 


Right kidney 



Right gonadal vessels 

Celiac trunk 

Middle suprarenal artery 


Left kidney 



Left gonadal vessels 

Right ureter 

Right common iliac artery 

Left ureter 

Psoas major 

Median sacral artery 


Iliacus 

Rectum 



Bladder 

184 

Vessels and their relationship to the posterior abdominal wall 


Diaphragm 

4 





Central tendon 

Esophagus with anterior and posterior 

vagal trunks 


Aortic hiatus 

and median 

arcuate ligament 

Left inferior phrenic 

artery 


nerve 

Hemi-azygos 

vein 

LI 


phrenic artery 

Azygos vein 

Rib XII 

Transverse process of LI 

Thoracic duct 

LII 

LIII 

LIV 


nerve 

Least splanchnic 

nerve 


Medial arcuate ligament 

Left crus 


Aorta 

Right crus 

Inferior view of diaphragm 

Psoas major 


Liver 

Stomach 

Pancreas 

Diaphragm 

Aorta 

Spleen 


Positioning of the diaphragm in relation to other structures. 


185 


ABDOMEN • Kidneys 

Coronary ligament of liver 



Root of hepato-esophageal 

ligament (part of lesser 

omentum) 

Esophagus 

Diaphragm 


Right triangular ligament 

Portal vein 


Right kidney 

(retroperitoneal) 

Duodenum 


Cut edges of peritoneum 

Right ureter 


Site of ascending colon 

Root of the mesentery 

Common iliac artery 





Root of splenorenal 

ligament (part of greater 

omentum) 

Pancreas (retroperitoneal) 

Attachment of transverse 

mesocolon (root of 

transverse mesocolon 

fused to posterior layers 

of greater omentum) 

Left kidney 




Left ureter (retroperitoneal) 


artery (retroperitoneal) 



Site of descending colon 

Cut edges of peritoneum 

Root of sigmoid 

mesocolon 

Superior rectal vessels 

Peritoneum and the retroperitoneal position of the kidneys 




Renal fascia 

Perinephric fat 

Kidney 


Paranephric fat 

Quadratus lumborum muscle 

Peritoneum 



Renal artery and vein 

Renal pelvis 

Psoas major muscle 

186 

Organization of fat and fascia surrounding the kidneys 


Kidneys 

4 

Rib XI 

Left kidney 

Left ureter 

Iliac crest 

Rib XII 

Right kidney 

Transverse processes 

of lumbar vertebrae 

Surface projection of the kidneys and ureters (posterior view) 

Rib XI 

Diaphragm 

Left kidney 

Right kidney 

Psoas major 

Rib XII 

Rib XII 


Structures related to the posterior surface of each kidney 



Stomach 

Spleen 

Right kidney 

Liver 

Pancreas 


Left kidney 

Descending part 

of duodenum 



Jejunum 


Structures related to the anterior surface of each kidney 

187 


ABDOMEN • Gross structure of kidneys 

Superior pole 

Fibrous capsule 

Medial border 

Lateral border 

Renal artery 

Renal vein 

Renal pelvis 

Ureter 

Inferior pole 

Anterior surface of right kidney 

Pyramid in renal medulla 

Renal column 

Renal cortex 

Major calyx 

Renal papilla 

Renal sinus 

Renal sinus 

Hilum of kidney 

Minor calyx 

Renal pelvis 

Ureter 

Internal structure of the right kidney 

188 


Kidneys: imaging 

4 

Liver 



Liver Inferior vena cava Abdominal aorta 

Right kidney Psoas major muscle 

Renal pelvis 

Renal pelvis 

Left kidney 

Right kidney 

Psoas major muscle 

Right ureter Left ureter Left kidney 

Renal pelvis. 


Location of ureters. 


Liver 

Spleen 

Left kidney 

Renal pelvis 

Right kidney 

Right ureter 

Psoas major 

Left ureter 

Bladder 

Pathway of ureter in relation to other structures. 

Coronal view of 3-D urogram using multidetector computed tomography 

189 


ABDOMEN • Renal vasculature 

Right superior suprarenal artery 

Celiac trunk 


Right suprarenal vein 

Right middle suprarenal artery 

Right inferior suprarenal artery 

Right renal vein 

Right renal artery 

Right kidney 


Inferior phrenic arteries 

Left superior suprarenal arteries 


Left middle suprarenal artery 

Left suprarenal vein 

Left inferior suprarenal artery 




Left kidney 



Right ureter 

Right gonadal vessels 

Left gonadal vessels 


Left ureter 



Right external iliac artery 


Right external iliac vein 

Right internal iliac artery 



Bladder 

Vasculature relating to kidneys, suprarenal glands, and ureters 

190 


Renal vasculature 

4 


Liver 




Spleen 



Right kidney 

Left kidney 

Renal vasculature. 


Liver 


Stomach 

Spleen 



Right kidney 

Left kidney 

Lumbar vertebra 

Psoas major 

Bladder 

Renal arteries. 





Celiac trunk 






Renal arteries. 

Volume-rendered anterior view using multidetector computer tomography 

191 


ABDOMEN • Branches of the abdominal aorta 

Celiac trunk 

Esophagus 

Recurrent branch of left 

inferior phrenic artery 

Diaphragm 


suprarenal arteries 


Right inferior phrenic artery 


suprarenal artery 

Right middle 

suprarenal artery 


Right kidney 

Left superior 

suprarenal arteries 

Left inferior suprarenal artery 

Left inferior phrenic artery 

Left middle suprarenal artery 






Psoas minor 

Lumbar arteries 

Right testicular 

(ovarian) artery 

Psoas major 

Iliac branch of 

iliolumbar artery 



Iliolumbar artery 

Internal iliac artery 


Superior gluteal artery 


Iliacus 

Inferior gluteal artery 

Middle rectal artery 



Left femoral artery 

192 

Abdominal aorta and branches 



4 

Right inferior phrenic vein 


Hepatic veins 

Esophagus 

Left inferior phrenic vein 


Azygos vein 


Right suprarenal vein 

Left suprarenal vein 

Renal veins 



Ascending lumbar veins 

Testicular 

(ovarian) veins 

Lumbar veins 

Iliolumbar veins 

Left ureter 

Common 

iliac veins 

Median sacral vein 

Lateral sacral veins 

Lumbar veins 



Right internal iliac vein 

Right superior gluteal vein 

Inferior vena cava and tributaries 

193

ABDOMEN • Abdominal aorta and inferior vena cava: imaging 

Liver 



Left kidney 

Right kidney 

Right common 

iliac artery 


Lumbar vertebra 

Left common 

iliac artery 

Psoas major 

Right common 

iliac artery 

Right common 

iliac vein 

Left common 

iliac vein 

Left common 

iliac artery 

Iliacus 

Right sacro-iliac joint 

Psoas major 

Sacrum 

Abdominal aorta and inferior vena cava. 


194

Abdominal aorta and inferior vena cava: imaging 

4 

Stomach 

Liver 

Spleen 


Right common 

iliac artery 


Left common 

iliac artery 

Right external 

iliac artery 

Iliacus 

Psoas major 

Left external 

iliac artery 

Bladder 

Liver 

Stomach 

Spleen 

Right kidney 


Left common 

iliac vein 


iliac artery 

Iliacus 


Left common 

iliac artery 

Psoas major 

Left external 

iliac artery 

Bladder 

Positioning of the abdominal aorta and inferior vena cava in relation to other structures. 

CT images, with contrast, in coronal plane 

195

ABDOMEN • Lumbar plexus 

Diaphragm 

LI 

Subcostal nerve 


Iliohypogastric nerve 

Ilio-inguinal nerve 


nerve of thigh 

Iliac fossa 

Genitofemoral nerve 


Lumbosacral trunk 

Femoral nerve 


LII 

LIII 

LIV 

LV 

Subcostal nerve 

(T12) 



(L1) 


(L1) 

Genitofemoral nerve 

(L1,L2) 

Psoas major 

Psoas minor 


nerve of thigh (L2,L3) 


(L4,L5) 

Genital branch 

Iliacus 

Femoral branch 

Femoral nerve 

(L2–L4) 



(L2–L4) 

Obturator foramen 

196 

Lumbar plexus

Lumbar plexus: cutaneous distribution 

4 

T10 

T11 

T12 

Lateral cutaneous branch of 


T12 

Anterior cutaneous branch of 



Genitofemoral nerve (L1,L2) 

Femoral branch of genitofemoral 

nerve (L1,L2) 


Lateral cutaneous nerve of 

thigh (L2–L3) 

Obturator nerve (L2–L4) 

Lateral cutaneous nerve of 

thigh (L2–L3) 

Cutaneous branch of obturator 

nerve (L2–L4) 

Intermediate cutaneous 

nerve from femoral nerve 

Medial cutaneous nerve 

from femoral nerve 

Femoral nerve (L2–L4) 

Saphenous nerve from 

femoral nerve 

Cutaneous distribution of the nerves from the lumbar plexus 

197

ABDOMEN • Lymphatics 

Esophagus 

Diaphragm 

Celiac nodes 

Intestinal trunk 




Right lumbar trunk 

with lateral aortic 

(lumbar) node 


artery 


Common iliac nodes 


nodes 



artery 

Pre-aortic nodes 

Inferior mesenteric nodes 

Left lumbar trunk 

Psoas major 

Psoas minor 

External iliac nodes 

Internal iliac nodes 


Rectum 



Bladder 

198 

Abdominal lymphatics

Abdominal innervation 

4 

Esophagus 

Anterior and posterior 

vagal trunks 



Right kidney 


and plexus 

Lumbar splanchnic nerve 


and ganglion 


Ureter and plexus 

Testicular (ovarian) 

artery and plexus 

Celiac ganglion 


Aorticorenal ganglion 


ganglion 

Aortic plexus 


ganglion 

Superior hypogastric 

plexus 


Right hypogastric nerve 


Pelvic splanchnic nerves 

(S2,3,4) 

Inferior hypogastric plexus 

Prevertebral plexuses and ganglia with sympathetic trunks 

199

ABDOMEN • Splanchnic nerves 

Cervical 

ganglia 


nerve 

Thoracic splanchnic nerves 

(sympathetics and visceral afferents) 

Anterior and posterior vagal trunks 




Thoracic 

ganglia 


nerve 



Superior hypogastric plexus 

Lumbar 

ganglia 



Sacral 

ganglia 

Lumbar splanchnic nerves 



Sacral splanchnic nerves 



(parasympathetics and visceral afferents) 

Splanchnic nerves 

200

Visceral efferent (motor) innervation diagram 

4 

Visceral efferent innervation to the 

abdominal gastrointestinal system 

Dorsal motor nucleus of vagus 

Medulla 

Right vagus 

Left 

vagus 




T5–L2 


FOREGUT 

Posterior vagal trunk 

(parasympathetic) 


(parasympathetic) 

Greater 

Lesser 

Least 

Lumbar 

Celiac ganglion 


(sympathetic) 

Liver 

Celiac artery 


ganglion 

Aorticorenal 

ganglion 

S2,3,4 


Stomach 

Spleen 

MIDGUT 

Superior 

mesenteric 

artery 

Prevertebral 

plexus 

Pancreas 


ganglion 

HINDGUT 

Inferior 

mesenteric 

artery 

Internal anal sphincter (smooth muscle) 

innervated by parasympathetic (S2,3,4) 

(relaxation) and sympathetic (L1,L2) (contraction) 

External anal sphincter (skeletal muscle) 

innervated by somatic efferent fibers (S2,3,4) 

in the pudendal nerve (not shown) 

Inferior 

hypogastric plexus 


(sympathetic) 


(parasympathetic S2,3,4) 

201

ABDOMEN • Visceral afferent (sensory) innervation and referred pain diagram 

C5 

C3 

C4 

C3,4,5 


Nuclei of solitary tract 

T(5)6–T11 


Medulla 

Right vagus 

Left 

vagus 

T6–T11 

Somatic “pain” referred to 

another somatic area of 

same spinal cord level 

T5–L2 


Intercostal nerves T(5)6–T11 

Phrenic nerves C3,4,5 

Greater 

Lesser 

Least 

Lumbar 




Liver 

FOREGUT 

Celiac artery 

S2,3,4 


“Irritation” of diaphragm 

by liver and gallbladder 

Stomach 

Spleen 

MIDGUT 

Superior 

mesenteric 

artery 

Pancreas 

HINDGUT 

Inferior 

mesenteric 

artery 

202 

Visceral afferent (follows parasympathetic) 

Visceral afferent (follows sympathetic) 


Visceral pain fibers mainly accompany sympathetic 

nerves back to the central nervous system. Other types 

of visceral sensory (afferent) fibers (related to reflex 

activities) follow mainly parasympathetic nerves

Visceral afferent (sensory) innervation and referred pain diagram 

4 

Visceral “pain” referred to somatic area 

innervated by same spinal cord level 

T4 

T5 

T6 

T7 

T8 

T9 

T10 

T11 

T12 

L1 

T4 

T5 

T6 

T7 

T8 

T9 

FOREGUT 

T10 

T11 

T12 

L1 

T4 

MIDGUT 

T5 

T6 

T7 

T8 

T9 

T10 

T11 

T12 

L1 

HINDGUT 

203

ABDOMEN • Kidney and ureter visceral afferent (sensory) diagram 

Dorsal motor nucleus of vagus 

“Pain” from kidneys referred to somatic area 

innervated by same spinal cord level 

Medulla 

Right vagus 

Left vagus 



T10–L1 


Stomach 

Suprarenal glands are innervated by 

numerous preganglionic sympathetic 

fibers that originate from the lower 

thoracic segments and pass through 

the celiac plexus. These preganglionic 

fibers synapse directly on medullary 

chromaffin cells of the gland 

S2,3,4 


Somatic sensory 

nerve fiber 

Right kidney 

Left kidney 

Right ureter 

Left ureter 





Visceral afferent 


(sympathetic) 


(parasympathetic S2,3,4) 

204

Kidney and ureter visceral afferent (sensory) diagram 

4 

T10 

T11 

T12 

L1 

T10–L1 dermatomes 

T10 

T11 

T12 

L1 

Pain fibers mainly follow sympathetic nerves to the central nervous system (CNS). This pain is 

‘referred’ by the CNS to the somatic area innervated by the same spinal levels. Other types of 

visceral afferent (sensory) fibers (related to reflex activities) follow mainly parasympathetic nerves 

205

ABDOMEN • Tables 

Abdominal wall muscles 



1 Muscular slips from the outer 

surfaces of the lower eight 

ribs (ribs V to XII) 

Lateral lip of iliac crest; 

aponeurosis ending in midline 

raphe (linea alba) 


lower six thoracic 

spinal nerves (T7 

to T12) 

Compress abdominal 

contents; both muscles flex 

trunk; each muscle bends 

trunk to same side, turning 

anterior part of abdomen to 

opposite side 


2 Thoracolumbar fascia; iliac 

crest between origins of 

external and transversus; 

lateral two thirds of inguinal 

ligament 

Inferior border of the lower 

three or four ribs; aponeurosis 

ending in linea alba; pubic 

crest and pectineal line 




to T12) and L1 


contents; both muscles flex 

trunk; each muscle bends 

trunk and turns anterior part 

of abdomen to same side 

Transversus 

abdominis 

3 Thoracolumbar fascia; medial 

lip of iliac crest; lateral one 

third of inguinal ligament; 

costal cartilages lower six ribs 

(ribs VII to XII) 

Aponeurosis ending in linea 

alba; pubic crest and 

pectineal line 




to T12) and L1 


contents 

Rectus 

abdominis 

4 Pubic crest, pubic tubercle, 

and pubic symphysis 

Costal cartilages of ribs V to 

VII; xiphoid process 


lower seven 

thoracic spinal 



contents; flex vertebral 

column; tense abdominal 

wall 

Pyramidalis 

5 Front of pubis and pubic 

symphysis 

Into linea alba 

Anterior ramus of 

T12 

Tenses the linea alba 

Posterior abdominal wall muscles 

Psoas major 

6 

Lateral surface of bodies of 

TXII and LI to LV vertebrae, 

transverse processes of the 

lumbar vertebrae, and the 

intervertebral discs between 

TXII and LI to LV vertebrae 

Lesser trochanter of the 

femur 

Anterior rami 

of L1 to L3 

Flexion of thigh at hip joint 

Psoas minor 

7 

Lateral surface of bodies of 

TXII and LI vertebrae and 

intervening intervertebral disc 

Pectineal line of the pelvic 

brim and iliopubic 

eminence 

Anterior rami 

of L1 

Weak flexion of lumbar 


Quadratus 

lumborum 

8 

Transverse process of LV 

vertebra, iliolumbar ligament, 

and iliac crest 

Transverse processes of LI 

to LIV vertebrae and inferior 

border of rib XII 


T12 and L1 to L4 

Depress and stabilize rib XII 

and some lateral bending of 

trunk 

Iliacus 

9 

Upper two thirds of iliac fossa, 

anterior sacro-iliac and 

iliolumbar ligaments, and 

upper lateral surface of 

sacrum 

Lesser trochanter of femur 

Femoral nerve 

(L2 to L4) 

Flexion of thigh at hip joint 

206

Tables 

4 

1 2 

3 

4 

5 

7 

8 

6 

9 

207

ABDOMEN • Tables 

Branches of the abdominal aorta 

Artery Branch Origin Parts supplied 

Celiac trunk 

1 Anterior Immediately inferior to the aortic hiatus 

of the diaphragm 

Abdominal foregut 

Superior 



artery 

Middle suprarenal 

arteries 

2 Anterior Immediately inferior to the celiac trunk Abdominal midgut 

3 Anterior Inferior to the renal arteries Abdominal hindgut 

4 Lateral Immediately superior to the renal arteries Suprarenal glands 

Renal arteries 

5 Lateral Immediately inferior to the superior 


Kidneys 

Testicular or 

ovarian arteries 

Inferior phrenic 

arteries 

Lumbar arteries 

Median sacral 

artery 

Common iliac 

arteries 

6 Paired anterior Inferior to the renal arteries Testes in male and ovaries in female 

7 Lateral Immediately inferior to the aortic hiatus Diaphragm 

8 Posterior Usually four pairs Posterior abdominal wall and spinal cord 

9 Posterior Just superior to the aortic bifurcation, 

passes inferiorly across lumbar 

vertebrae, sacrum, and coccyx 

10 Terminal Bifurcation usually occurs at the level of 

LIV vertebra 

Branches of the lumbar plexus 

Branch Origin Spinal segments Function: motor Function: sensory 

Iliohypogastric 

1 Anterior 

ramus L1 

L1 

Internal oblique and transversus 

abdominis 

Posterolateral gluteal skin and skin 

in pubic region 

Ilio-inguinal 

2 Anterior 

ramus L1 

L1 

Internal oblique and transversus 

abdominis 

Skin in the upper medial thigh, and 

either the skin over the root of the 

penis and anterior scrotum or the 

mons pubis and labium majus 

Genitofemoral 

3 Anterior rami 

L1 and L2 

L1, L2 Genital branch—male cremasteric 

muscle 

Genital branch—skin of anterior 

scrotum or skin of mons pubis and 

labium majus; femoral branch—skin 

of upper anterior thigh 

Lateral 

cutaneous 



L2 and L3 

L2, L3 Skin on anterior and lateral thigh 

to the knee 

Obturator 


L2 to L4 

L2 to L4 

Obturator externus, pectineus, and 

muscles in medial 

compartment of thigh 

Skin on medial aspect of the thigh 

Femoral 


L2 to L4 

L2 to L4 

Iliacus, pectineus, and muscles 

in anterior compartment of thigh 

Skin on anterior thigh and medial 

surface of leg 

208

Tables 

4 

7 

4 

1 

2 

5 

8 

6 

3 

9 

10 

L1 

1 

2 

3 

4 

L2 

L3 

L4 

6 

5 

209


5 

CONTENTS 

PELVIS AND PERINEUM 

Surface anatomy and articulated pelvis in men 212 

Surface anatomy and articulated pelvis in women 214 

Pelvic girdle 216 

Pelvic girdle: imaging 217 

Lumbosacral joint 218 

Sacro-iliac joint 219 

Pelvic inlet and outlet 220 

Orientation of pelvic girdle and pelvic brim 221 

Pelvic viscera and perineum in men 222 

Pelvic viscera and perineum in men: imaging 223 

Pelvic viscera and perineum in women 224 

Pelvic viscera and perineum in women: imaging 225 

Lateral wall of pelvic cavity 226 

Floor of pelvic cavity: pelvic diaphragm 227 

Rectum and bladder in situ 230 

Rectum 231 

Bladder in men 232 

Bladder in women 233 

Reproductive system in men 234 

Prostate 235 

Prostate and seminal vesicles 237 

Scrotum 238 

Testes 239 

Penis 240 

Reproductive system in women 241 

Uterus and ovaries 242 

Uterus 243 

Uterus: imaging 244 

Pelvic fascia 245 

Arterial supply of pelvis 246 

Venous drainage of pelvis 247 

Vasculature of the pelvic viscera 248 

Vasculature of uterus 249 

Venous drainage of prostate and penis 250 

Venous drainage of rectum 251 

Sacral and coccygeal nerve plexuses 252 

Pelvic nerve plexus 253 

Hypogastric plexus 254 

Surface anatomy of the perineum 255 

Borders and ceiling of the perineum 258 

Deep pouch and perineal membrane 259 

Muscles and erectile tissues in men 260 

Erectile tissue in men: imaging 261 

Muscles and erectile tissues in women 262 

Erectile tissue in women: imaging 263 

Internal pudendal artery and vein 264 

Pudendal nerve 265 

Vasculature of perineum 266 

Nerves of perineum 267 

Lymphatics of pelvis and perineum in men 268 

Lymphatics of pelvis and perineum in women 269 


Dermatomes 271 

Innervation of reproductive system in men 272 

Innervation of reproductive system in women 273 

Innervation of bladder 274 

Pelvic cavity imaging in men 275 

Pelvic cavity imaging in women 278 

Tables 284

PELVIS AND PERINEUM • Surface anatomy and articulated pelvis in men 

Umbilicus 



Anterior inferior iliac spine 





Scrotum 

Glans of penis 

Ramus of ischium 

Inferior pubic ramus 

Surface anatomy with bones (anterior view) 

Iliac crest 

Iliac fossa 


Ala of sacrum 

Promontory 

Sacrum 


Ischial spine 

Coccyx 


iliac spine 

Anterior sacral foramina 

Arcuate line 

Acetabulum 

Superior pubic ramus 





Pecten pubis 

(pectineal line) 

Subpubic angle 

(50º–60º in men) 

Articulated pelvis (anterior view) 

212

Surface anatomy and articulated pelvis in men 

5 

Iliac crest 


Posterior inferior iliac spine 

Ischial spine 


Ischial tuberosity 

Gluteal fold 

Surface anatomy with bones (posterior view) 

Iliac crest 

Gluteal surface 

of ilium 




iliac spine 

Sacrum 


Greater sciatic notch 

Sacral hiatus 

Coccyx 

Ischial spine 




Body of pubis 

Inferior pubic ramus Pubic symphysis 

Articulated pelvis (posterior view) 


213

PELVIS AND PERINEUM • Surface anatomy and articulated pelvis in women 

Umbilicus 

Iliac crest 










Surface anatomy with bones (anterior view) 

Iliac crest 




Iliac fossa 

Promontory 


iliac spine 

Sacrum 



Ischial spine 

Coccyx 

Acetabulum 







(80º–85º in women) 

Articulated pelvis (anterior view) 

214

Surface anatomy and articulated pelvis in women 

5 

Iliac crest 

Iliac crest 

Sacral dimple 

(location of posterior superior iliac spine) 


Ischial spine 

Intergluteal cleft (natal cleft) 


Gluteal fold 

Surface anatomy with bones (posterior view) 

Iliac crest 



Sacral canal 


iliac spine 


iliac spine 

Sacrum 

Sacral hiatus 

Posterior sacral 

foramina 


Sacral cornua 

Coccyx 

Ischial spine 








Articulated pelvis (posterior view) 

215

PELVIS AND PERINEUM • Pelvic girdle 

Iliac crest 

Iliac fossa 

Sacral canal 


iliac spine 

Arcuate line of ilium 


Greater 

sciatic notch 

Iliopubic eminence 

Anterior 

superior 

iliac spine 

Iliac fossa 

Iliac crest 

Pecten pubis (pectineal line) 



Ischial spine 

Lesser 

sciatic notch 



Coccyx 

Sacrum 



Sacral canal 

Pelvic girdle in men 

with left pelvic bone removed 

(anterolateral superior view) 

Arcuate 

line of 

ilium 

Greater sciatic 

notch 

Anterior 

inferior 

iliac spine 

Iliopubic 

eminence 

Pecten pubis 


Superior pubic 

ramus 

Ischial spine 

Lesser sciatic 

notch 


Sacrum 



Coccyx 

Pubic crest 



Pelvic girdle in women 

with left pelvic bone removed 

(anterolateral superior view) 

216

Pelvic girdle: imaging 

5 

Ilium 


Sacrum 

Acetabulum 

Head of femur 






Femur 


(smaller in men than in women) 

Male bony pelvis. 




Ilium 

Sacrum 


Acetabulum 






Femur 


(larger in women than in men) 


Female bony pelvis. 


217

PELVIS AND PERINEUM • Lumbosacral joint 


Body of vertebra LV 

Iliolumbar ligament 

Transverse 

process of LV 

Lumbosacral 

ligament 


(between LV and SI) 

Sacrum 

Greater sciatic foramen 


iliac spine 

Anterior sacro-iliac 

ligament 

Sacrospinous ligament 

Lesser sciatic foramen 

Coccyx 

Ischial spine 

Anterior sacrococcygeal ligaments 

Sacrotuberous ligament 




Lumbosacral joints and associated ligaments (anterior view) 

Zygapophysial joint between LV and SI 

Iliolumbar ligament 


Lumbosacral ligament 

Supraspinous 

ligament 


iliac spine 

Interosseous sacro-iliac 

ligament 


iliac spine 

Posterior sacro-iliac 

ligaments 




Deep posterior sacrococcygeal ligament 

Ischial spine 

Superficial posterior 

sacrococcygeal ligaments 





Pubic 

symphysis 

218 

Lumbosacral joints and associated ligaments (posterior view)


5 



Zygapophysial joint between LV and SI 


(between LV and SI) 

Anterior sacro-iliac ligament (cut) 

Posterior sacro-iliac ligament (cut) 

Interosseous sacro-iliac ligament (cut) 

Articular surface of sacrum 






Coccyx 





Ischial spine 

Sacro-iliac joints and associated ligaments (lateral view with left pelvic bone removed) 



Pubic crest 

Anterior sacrococcygeal ligaments 

Ischial spine 


Coccyx 


Anterior longitudinal 

ligament 



Body of SI 

Anterior sacro-iliac ligament 

Posterior sacro-iliac ligament 

Sacro-iliac joints (anterosuperior view) 

219

PELVIS AND PERINEUM • Pelvic inlet and outlet 

Pubic crest 






iliac spine 



Ischial spine 

Coccyx 

Arcuate line 

of ilium 

Iliac crest 

Sacral 

promontory 


Iliac fossa 


Sacral canal 


Pelvic inlet (shown in red; anterosuperior view) 



Ischiopubic ramus 






iliac spine 

Acetabulum 

Gluteal 

surface 

(of ilium) 


Sacrum 



Coccyx 

Pelvic outlet (shown in green; anteroinferior view) 

220

Orientation of pelvic girdle and pelvic brim 

5 


iliac spine 

Anterosuperior margin 

of pubic symphysis 

Pelvic orientation in anatomical position (lateral view) 




iliac spine 


Sacrum 



Ischial spine 




Pubic crest 



Pelvic inlet (shown in red; anterior view) 

221

PELVIS AND PERINEUM • Pelvic viscera and perineum in men 

Common 

iliac artery 

Common 

iliac vein 

Vertebra LV 



Iliacus 

Ureter 

Parietal 

peritoneum 


Inferior epigastric 




Sigmoid colon 

Visceral peritoneum 

Urachus 

Spongy urethra 

Bladder 


Retropubic 

(potential) space 

Suspensory ligament of penis 

Prostate 

Prostatic urethra 

Membranous urethra 

Corpus cavernosum 

Corpus spongiosum 

Rectovesical 

pouch 

Rectum 

Levator ani 

Deep part of 

external anal sphincter 

Superficial part of 


Subcutaneous part of 



External urethral orifice 

Anal canal 

Testis 

Internal anal sphincter 

External urethral sphincter 

Bulb of penis 

Bulbospongiosus 

Pelvic viscera and perineum in men in situ (sagittal section) 

222

Pelvic viscera and perineum in men: imaging 

5 

Bladder 

Prostatic 

venous plexus 

Prostate 

Rectum 


Membranous 

urethra 



Anal canal 




Glans penis 

Pelvic viscera in men. 

Fat-saturated T2-weighted MR image in sagittal plane 

223

PELVIS AND PERINEUM • Pelvic viscera and perineum in women 

Common 

iliac artery 

Common 

iliac vein 

Iliacus 

Ureter 

Peritoneum 


Inferior epigastric 



Ovary 

Ligament of the ovary 


of uterus 

Body of uterus 

Urachus 

Bladder 


Urethra 

Glans of clitoris 

Labium minus 

Labium majus 

Vertebra LV 




of ovary 

Uterine tube 

Sigmoid colon 

Vesicouterine 

pouch 

Uterosacral 

ligament 

Posterior fornix 

of vagina 

Rectouterine 

pouch 

Cervix of uterus 

External os 


Levator ani 

Rectum 

Deep part of 

external anal 

sphincter 






Anal canal 

Vagina 


Vaginal orifice 

Pelvic viscera and perineum in women in situ (sagittal section) 

224

Pelvic viscera and perineum in women: imaging 

5 


Vertebra SII 


Rectum 

Uterus 

Bladder 

Retropubic 

(potential) space 

Urethra 

Vagina 

Anal canal 


Pelvic viscera in women. 


225

PELVIS AND PERINEUM • Lateral wall of pelvic cavity 

Iliac crest 



iliac spine 

Piriformis 

Sacrum 





Coccyx 





Obturator internus and piriformis muscles (oblique medial view) 


Iliac crest 

Posterior sacro-iliac ligaments 


Piriformis 


Iliofemoral ligament 


Greater trochanter of femur 

Ischiofemoral ligament 


Tendon of obturator internus 


226 

Obturator internus and piriformis muscles (posterior view)

Floor of pelvic cavity: pelvic diaphragm 

5 

Iliac crest 





iliac spine 

Piriformis 

(passing out of greater 

sciatic foramen) 

Sacrum 

Ischial spine 

Fascia covering the 

obturator internus 

Tendinous arch 

(of levator ani) 

Coccygeus 

(ischiococcygeus) 

Coccyx 


Puborectalis 

(part of levator ani) 

Anal aperture 


Iliococcygeus 


Urogenital hiatus 

Pubococcygeus 


Levator ani and coccygeus (ischiococcygeus) muscles (oblique sagittal view) 

227

PELVIS AND PERINEUM • Floor of pelvic cavity: pelvic diaphragm 

Anal aperture 



Pubococcygeus 






Iliococcygeus 


Anococcygeal ligament 

Ischial spine 

Coccygeus 


Sacrotuberous 

ligament 

Piriformis 

Sacrospinous 

ligament 

Anterior 

sacrococcygeal 

ligament 

Sacral canal 

Sacrum 

Levator ani and coccygeus (ischiococcygeus) muscles (anterosuperior view) 

Ilium 

Epiphysial cartilage 

Rectum 

Ischium 



Pelvic diaphragm 

(levator ani and coccygeus) 


Anal region 

228 

Pelvic diaphragm in relation to other structures in 

the pelvic cavity and perineum. 

T2-weighted MR image in coronal plane

Floor of pelvic cavity: pelvic diaphragm 

5 




Inferior pubic ligament 


Pubococcygeus 



Ischial spine 

Puborectalis 

(part of 

levator ani) 

Anal aperture 

Tendon of obturator 

internus 

Piriformis 


Iliococcygeus 


Coccyx 

Levator ani muscle (inferior view) 

Bladder 


Vagina 


Pudendal canal 




Rectum 

Obturator internus muscle and its relationship to other pelvic structures. 

Fat-saturated T2-weighted MR image in axial plane 

229

PELVIS AND PERINEUM • Rectum and bladder in situ 

Sigmoid colon 

Vesical fascia 

Ureteric orifice 

Trigone 

Urachus (cut) 

Detrusor muscle 


Internal urethral sphincter 

Prostate 




Rectum 

Deep transverse perineal muscle 


Anal canal 





Deep part of external anal sphincter 

Bladder, prostate, and rectum within pelvic cavity in men (oblique sagittal view) 

230

Rectum 

5 

Sacrum 

Uterus 

Rectum 

Uterus 

Bladder 

Bladder 

Vagina 

Rectum 


Urethra 

Vagina 

Anal canal 

Surface projection of the rectum in women 

Positioning of the rectum and anal canal in relation 

to the other female pelvic viscera. 


Iliacus 



Rectal fascia 

Cut edge of peritoneum 

Longitudinal muscle of rectum 

Circular muscle of rectum 

Mucosa of rectum 


Ureter 


Middle transverse fold 

of rectum 

Iliococcygeus 



Pudendal canal with 

vessels and nerve 

Pubococcygeus 


Fat filling ischio-anal fossa 

Anal valve 

External anal sphincter 

Anal crypt 

Anal columns 




Iliococcygeus 


Bladder 

Inferior transverse fold 

of rectum 


Pudendal canal in 

fascia of obtuator 

internus 

Puborectalis 


Internal rectal 

venous plexus 


External rectal venous plexus 

Intersphincteric groove 

Anal sinus 

Coronal section through rectum and anal canal (posterior view) 

231

PELVIS AND PERINEUM • Bladder in men 

Right ureter 

Iliac crest 

Bladder 

Pelvic bone 

Bladder 

Sacrum 

Obturator 

foramen 


Left ureter 

Prostate 

Rectum 

Prostate 


Puboprostatic ligament 

Inferior pubic 

ramus 



Surface projection of the bladder in men (lateral view) 

Right ureter 

Ureteric orifice 

Left ureter 

Vesical fascia 

Trigone 

Apex 

Fundus 

Urachus (cut) 


Capsule of prostate 

Prostate 

Bladder neck 

(internal urethral 

sphincter) 

Fibromuscular stroma 


Prostate 

Urinary bladder in men 

232

Bladder in women 

5 

Right ureter 

Iliac crest 

Bladder 

Pelvic bone 

Uterus 

Bladder 

Inferior pubic 

ramus 

Obturator 

foramen 

Sacrum 


Rectum 

Urethra 

Pubovesical ligament 

Urethra 

Left ureter 

Vaginal opening 



Pubovesical ligament 

Surface projection of the bladder in women (lateral view) 

Right ureter 

Ureteric orifices 

Left ureter 

Uterus 

Acetabulum 

Ilium 

Trigone 

Intra-ureteric fold 

Urethra 


Compressor urethrae 

Sphincter urethrovaginalis 

Bladder 


Neck of femur 

Urinary bladder and urethral sphincter 

muscles in women (anterior view of posterior wall) 

Appearance and positioning of the bladder in relation 

to other structures in the female pelvic cavity. 

T2-weighted MR image in coronal plane 

233

PELVIS AND PERINEUM • Reproductive system in men 





Right internal 

iliac artery 

Right external iliac artery 


Right ductus deferens 




Obturator artery and vein 


Coccygeus 


Ampulla of 

ductus deferens 

Left ureter 

Left ductus deferens 

Seminal vesicle 

Iliococcygeus 

Ejaculatory duct 


Pubococcygeus 

Prostate 


Bulbo-urethral gland 






Dartos fascia 




Superficial perineal fascia 

(Colles’ fascia) 

Navicular fossa 


Cremaster muscle 

Musculofascial pouch (terminal expansion of 

the spermatic cord) 

Tunica vaginalis (parietal and visceral layer 

enclosing cavity of tunica vaginalis) 

Reproductive system in men (oblique sagittal view) 

234

Prostate 

5 

Ureteric orifices 

Trigone 


Bladder neck 

(internal urethral sphincter) 

Prostatic plexus of veins 

Openings of prostatic ducts 

Prostatic utricle 

Openings of ejaculatory ducts 


Membranous urethra 

Superficial perineal pouch 

Levator ani muscle 

Fibromuscular stroma 

Glandular elements of prostate 

Prostatic sinus 

Capsule of prostate 

Seminal colliculus 




Midline raphe 


Bulbospongiosus muscle 

Coronal secion through bladder and prostate (anterior view) 

Ilium 

Bladder 

Prostate 

Rectum 



Ilium 

Ampulla of ductus deferens 

Rectum 



Ischium 

Urethra 


Femur 

Appearance and positioning of bladder and prostate in relation to 

other structures in the male pelvis and perineum. 

Fat-saturated T2-weighted MR image in coronal plane 

Ischium 

Prostate 


Femur 

Appearance and positioning of ductus deferens 

and seminal vesicles in relation to other structures 

in the male pelvis and perineum. 


235

PELVIS AND PERINEUM • Prostate 



Urethra 

Ejaculatory duct 

Transitional zone 

Central zone 

Peripheral zone 

Anterior region 

(non-glandular) 

Bladder 

Urethra leaving bladder 


Area of seminal colliculus 


Penile urethra 

Zonal anatomy of the prostate gland. 

Most carcinomas originate in the peripheral zone. 

Benign prostatic hypertrophy (BPH) 

affects mainly the transitional zone 


Probe in rectum 

Prostate 

Rectal ultrasound imaging of the prostate, bladder, and 

seminal vesicle. Sagittal view also showing the urethra 


Pubic bone 

Central zone 

Prostatic venous plexus 

236 


Boundaries of prostate 

Rectal ultrasound imaging of the prostate. 

Axial view showing the central and peripheral zones 

Prostate 



Axial view showing the surrounding plexus of veins

Prostate and seminal vesicles 

5 


Central zone 

Urethra 

Prostate 


Boundaries of prostate 


Sagittal view showing the central and peripheral zones 

Seminal colliculus 



Axial view showing the urethra and seminal colliculus 

Transverse vesical fold 

Left ureter 

Peritoneum 

Urinary bladder 

Right ureter 





Prostate 

Beginning of ejaculatory duct 

Bladder and prostate (posterior view) 

237

PELVIS AND PERINEUM • Scrotum 

Superficial fascia: Scarpa’s layer 


Aponeurosis of internal oblique 


Superficial 

epigastric 




Femoral vein 


Superficial external 

pudendal 




Fundiform ligament 

of penis 

Deep external pudendal 


Deep fascia of penis (Buck’s fascia) 

Superficial dorsal vein of penis 

Deep dorsal vein and dorsal arteries of penis 





Dartos fascia 

Skin of scrotum 

Septum of scrotum 

Pampiniform plexus of veins and testicular artery 



Parietal layer of tunica vaginalis 

Cavity of tunica vaginalis 

Appendix of epididymis 

Appendix of testis 

Contents of the scrotum (anterior view) 

Dartos fascia 


Testicular artery 

Pampiniform plexus of veins 

Parietal layer 

Body of epididymis 

Tunica vaginalis 

Cavity 

Visceral layer 

Internal spermatic fascia 

Lobules of testis 



Skin of scrotum 

Transverse section through the scrotum and testes 

238

Testes 

5 


Bladder 


Bladder 

Femoral vessels 


Testis 

Penis 

Testis 



Testis 

Penis 

Testis 


Spermatic cord appearance and positioning in a young male. 

T1-weighted MR images in coronal plane 

Ductus deferens (and artery of ductus deferens) 

Ligamentous remnant of processus vaginalis 

Testicular artery 

Pampiniform plexus of veins 

Seminiferous tubule 


Lobule 

Efferent ductules 

Tunica vaginalis 

Parietal layer 

Cavity 

Visceral layer 

Rete testis in mediastinum testis 

Body of epididymis 

Septum 

Straight tubule 

Capsule 

(tunica albuginea) 

Tail of epididymis 

Testis and surrounding structures 

239

PELVIS AND PERINEUM • Penis 

Superficial fascia of penis 


Fundiform ligament of penis 

Penile skin 


Deep fascia of penis (Buck’s fascia) 

Tunica albuginea of corpus cavernosum 


Midline raphe 



Ischiocavernosus 


External urethral 

orifice 

Prepuce of penis 


Superficial 

transverse 

perineal muscle 

Perineal body 

Frenulum 

of prepuce 

Structure of the penis 




Navicular fossa 


Lower part of trigone 



Tunica albuginea 

Prostate 



(displaced from glans) 

Deep artery of penis 


Bulbo-urethral duct 


Crus of penis 

Corpus spongiosum (enclosing urethra) 


Glans penis 

Openings of 

bulbo-urethral 

ducts 

Opening to membranous part of urethra 


Structure of the penis 

Roof of spongy urethra (inferior view) 

240

Reproductive system in women 

5 

Piriformis 

Coccygeus 


Ovary 

Uterine tube 

Ligament of ovary 






of uterus traversing 

inguinal canal 

Urachus 

Bladder 

Rectum 

Levator ani 

Posterior fornix 

of vagina 


External os of uterus 


Anal canal 

Urethra 



Vagina 


Crus of clitoris 

Bulb of vestibule 

Greater vestibular gland 

Reproductive system in women (oblique sagittal view) 

241

PELVIS AND PERINEUM • Uterus and ovaries 

Suspensory ligament of ovary 

Uterine tube 


Fundus of uterus 

Isthmus 

Intramural 

(uterine) part 

Uterine tube 

Ampulla 

Infundibulum 

Folds of uterine tube 

Left ovary 



Follicle 


Myometrium 

Endometrium 

Fimbriae 

Corpus albicans 

Corpus luteum 

Right ovary 

Internal os 


Cervical canal with palmate folds 

Vaginal cervix 

Uterus 

Lateral fornix of vagina 

External os 

Vagina 

Vaginal wall 

Surface projection of the uterus 

Structure of the uterus and ovaries (posterior view) 

Uterine tube 

Folds of uterine tube 


of ovary 

Secondary (antral) follicle 

Primordial follicles 

Atretic follicle 

Hilum 

Primary follicle 


Fimbriae 

Surface epithelium of ovary 

Corpus albicans 


Regressing corpus luteum 

Tertiary (graafian) follicle 

Active corpus luteum 

Ovarian vessels 

Oocyte at ovulation 

Ruptured follicle 

Structure of the uterine tube and ovary (posterior view) 

242

Uterus 

5 


Mesosalpinx 

of broad ligament 

ligament of ovary 


Mesosalpinx 

Uterine tube 


Left ovary 

Mesometrium of 

broad ligament 


peritoneum 

(mesometrium) 

Ureteric fold 

Left ureter 

Uterosacral ligament 

Right ureter 

Right ovary 

Mesovarium of 


Fimbriae 


Mesometrium 


Recto-uterine pouch 


Vagina 

Vaginal wall 

Uterus and broad ligament (posterior view) 

Uterine tube 

Mesosalpinx 

Epoophoron 

Vesicular appendix 


Abdominal ostium 

Ovary 

Uterine tube and ovary (posterior view) 

243

PELVIS AND PERINEUM • Uterus: imaging 

A 

Bladder 


Rectum 






B 




Uterus 

Right ovary 

Left ovary 

Rectum 

C 



Right uterine tube 

Uterus 

Ilium 

Left uterine tube 

Rectum 

244 

Appearance of cervix of uterus, uterus, ovaries, and uterine tubes 

in relation to other pelvic structures. 

Fat-saturated T2-weighted MR images in axial plane

Pelvic fascia 

5 

Inferior vesical vein 


Coccygeus (ischiococcygeus) 

Superior 

vesical vein 

Iliococcygeus 

Rectum 


Prostate 


Left internal pudendal artery and vein 

Pubococcygeus 

Left dorsal 

artery of penis 

Rectovesical septum 

Prostatic fascia 


Deep dorsal vein of penis 

Pelvic fascia and related structures in men 

Recto-uterine pouch 


Transverse cervical ligament 

Pubocervical ligament 


Vesico-uterine pouch 

Bladder 

Rectum 

Levator ani 

Urethra 

Pelvic fascia and related structures in women 

Anal canal 

Vagina 

Rectovaginal septum 


245

PELVIS AND PERINEUM • Arterial supply of pelvis 




Iliacus 

Lumbosacral trunk (L4,5) 


Lateral sacral arteries 


Ascending branch of 

deep circumflex 

iliac artery 




Umbilical artery 


Inferior epigastric vein 

Superior vesical artery 

Pubic branch 

of inferior 

epigastric artery 


S1 

S2 

S3 

S4 

Piriformis 

Inferior gluteal 

artery 

Internal pudendal 

artery 

Pudendal nerve 

Obturator artery 

Coccygeus 



Medial umbilical 

ligament (obliterated 

umbilical artery) 


Inferior rectal artery 

Dorsal artery of penis or clitoris 

Inferior vesical artery 

(in men or vaginal artery in women) 

Iliococcygeus (part of levator ani) 

Pubococcygeus (part of levator ani) 

Arterial supply to the pelvis 

(right side sagittal view) 

246

Venous drainage of pelvis 

5 

Right common iliac vein 


Iliacus 


Superior gluteal vein 

Lateral sacral vein 


Median sacral vein 




S1 

S2 

Inferior epigastric vein 


Superior vesical vein 


Obturator vein 

Pubic tributary to 

the inferior 

epigastric vein 

Piriformis 


vein 



vein 

Coccygeus 


Medial umbilical 

ligament (obliterated 

umbilical artery) 




Vesical plexus of veins 

Perineal vein 


Pubococcygeus (part of levator ani) 

Veins of the pelvis 

(right side sagittal view) 

247

PELVIS AND PERINEUM • Vasculature of the pelvic viscera 

Superior rectal artery and vein 

from inferior mesenteric vessels 





iliac artery 

Right ureter 

Middle rectal 

artery 

Iliolumbar vein 





Left ureter 

Rectum 

Note: 

uterine artery 

crosses ureter 

Uterine artery 


Uterine vein 


Vaginal artery 




Bladder 

Uterus 


Vasculature of the pelvic viscera in women (superior view) 


from inferior mesenteric vessels 




Right internal iliac 

artery 

Right ureter 


artery 

Iliolumbar vein 





Left ureter 

Rectum 











Bladder 

248 

Vasculature of the pelvic viscera in men (superior view)

Vasculature of uterus 

5 

Mesosalpinx of broad ligament 


Tubal branch of uterine artery and vein 

Ovarian artery and vein in 

suspensory ligament of ovary 

Uterine tube 

Ovarian artery 

and vein 

Left ovary 

Mesometrium of 



peritoneum 

(mesometrium) 

Left ureter 

Uterine artery and vein 


Fimbriae 

Right ovary 

Ovarian branch of uterine artery and vein 



Right ureter 


Uterine vein 



Vagina 

Vaginal artery 

Vaginal wall 

Vascular supply to uterus (posterior view) 



Catheter 




(traumatized) 




Vascular supply to uterus. 

Angiogram 

249

PELVIS AND PERINEUM • Venous drainage of prostate and penis 



Right internal iliac 


Right external iliac 



pudendal 



(covered by fascia) 




Iliococcygeus 

Vesical plexus 

Pubococcygeus 


Prostate 


Coccygeus 


Inferior rectal artery 

and vein 

Rectum 

Pubococcygeus 

Left internal pudendal 


Left dorsal artery of penis 

Deep transverse perineal 





Left dorsal artery of penis 

Posterior scrotal artery and vein 


250 

Venous drainage of pelvic viscera in men 

(oblique sagittal view)

Venous drainage of rectum 

5 



(from inferior mesenteric vessels) 


Peritoneum 

Median sacral artery and vein 

(from aorta and inferior vena cava) 






Bladder 

Iliococcygeus 



Internal pudendal artery 

and vein in pudendal canal 

Pubococcygeus 


Inferior rectal 





Communication between 

internal and external 

rectal plexus 



Perimuscular rectal 

venous plexus 

Internal pudendal vein 

in pudendal canal 


External anal sphincter 

Subcutaneous part of external anal sphincter 

Internal rectal plexus 

Internal anal sphincter Pectinate External rectal plexus 

line 

Vasculature of the rectum (posterior view) 



Urethra 

Vagina 


Anal region 

Femur 




Inferior rectal branch to anal region 

Inferior rectal neurovascular bundle crossing the ischio-anal fossa. 


251

PELVIS AND PERINEUM • Sacral and coccygeal nerve plexuses 

Anterior rami of spinal nerves 

Dorsal divisions 


Ventral divisions 

L4 

Superior gluteal 

L5 


S1 

Sacral plexus 

Sciatic nerve 

To piriformis muscle 

Tibial part 

Common fibular part 

To quadratus femoris and inferior gemellus muscles 

To obturator internus and superior gemellus muscles 

Posterior femoral cutaneous nerve 


(preganglionic parasympathetics from S3–S4) 

S2 

S3 

S4 

S5 

Co 


Pelvic splanchnic nerve 

(preganglionic parasympathetics 

from S2) 

Perforating cutaneous nerve 

To levator ani, coccygeus, and 

external anal sphincter muscles 

Anococcygeal nerves 

Coccygeal plexus 

Components and branches of the sacral and coccygeal nerve plexuses 

L4 


L5 

Nerve to piriformis muscle 

S1 

S2 

Superior gluteal nerve 

Inferior gluteal nerve 

Perforating cutaneous nerve 

Sciatic nerve 

Nerve to obturator internus 

and superior gemellus 


(from lumbar plexus) 

S3 

S4 


(preganglionic parasympathetics 

from S2 to S4) 



Nerve to quadratus femoris 

and inferior gemellus 


Nerves to coccygeus, levator ani, 

and external anal sphincter 

Posterior femoral cutaneous nerve 

252 

Sacral and coccygeal nerve plexuses within the pelvic cavity (sagittal view)

Pelvic nerve plexus 

5 



Right lumbar sympathetic trunk 

Left lumbar sympathetic trunk 





Right hypogastric 

nerve 

Sacral splanchnic 

nerves to inferior 


(postganglionic 

sympathetic) 


nerve 

Pelvic splanchnic 

nerves 

(preganglionic 

parasympathetics 


Inferior hypogastric 

plexus 




Left hypogastric 

nerve 

Superior 

gluteal nerve 

Greater sciatic 

foramen 


nerves to inferior 


(postganglionic 

sympathetic) 


nerves 

(preganglionic 

parasympathetics 


Piriformis 


Coccygeus 


Iliococcygeus 


Pubococcygeus 


Pelvic extensions of the prevertebral nerve plexus (anterior view) 

253

PELVIS AND PERINEUM • Hypogastric plexus 

Right sympathetic trunk and ganglion 


Left sympathetic trunk and ganglion 


S1 

S2 


Piriformis 



S3 

S4 


nerves (preganglionic 

parasympathetic) 


nerves (sympathetics) 





Levator ani 


Nerves to coccygeus, 

levator ani, and 

external anal 

sphincter 

Coccygeus 




Prostate 

Rectum 




Prostatic plexus 


Cavernous nerve 


Hypogastric nerve plexuses 

(oblique sagittal view) 

254

Surface anatomy of the perineum 

5 

Body of penis 


Testicles in scrotum 

Muscles of 

the thigh 




Superficial transverse 



Anal aperture 


Levator ani 

Structures of the perineum in men 


Approximate position of 

perineal body 

(central tendon) 

Urogenital triangle 



Anal triangle 

Coccyx 

Surface anatomy of the perineum in men 

255

PELVIS AND PERINEUM • Surface anatomy of the perineum 

Labium minus 

Labium majus 

Mons pubis 




Muscles of the thigh 

Urethral opening 




Anal aperture 


Superficial transverse perineal muscle 

Levator ani 

Structures of the perineum in women 

Mons pubis 


Approximate position of 

perineal body 

(central tendon) 

Urogenital triangle 



Anal triangle 

Coccyx 

Surface anatomy of the perineum in women 

256

Surface anatomy of the perineum 

5 



Testis in scrotum 


Scrotal raphe 

Superficial features of the perineum in men 

Prepuce of clitoris 

Frenulum of clitoris 

Urethral opening 


Vestibule 

Opening of duct of para-urethral gland 

Labium minus 

Hymen 

Opening of duct of greater vestibular gland 


Fourchette 

Skin overlying body of clitoris 


Labium minus 

Vestibule 

Labium majus 

Vaginal opening (introitus) 

Posterior commissure 

(overlies perineal body) 

Superficial features of the perineum in women 

257

PELVIS AND PERINEUM • Borders and ceiling of the perineum 


Puborectalis 


Pubococcygeus 





Acetabulum 

Tendon of 

obturator 

internus 




Piriformis 

Iliococcygeus 


Puborectalis 



Pubococcygeus 


Coccyx 

Borders and ceiling of the perineum in men 





Anal aperture 


Acetabulum 


obturator 

internus 

Piriformis 



Coccyx 

Anal aperture 



Palpable landmarks 

Borders and ceiling of the perineum in women 

258

Deep pouch and perineal membrane 

5 




(removed on opposite side) 


Urethra 


Ischiopubic arch 


Perineal body 



internus 


Piriformis 


muscle 

Puborectalis 

Pubococcygeus 

Iliococcygeus 

Anus 

Levator ani 

Muscles of deep perineal pouch in men 

(perineal membrane removed on left side to expose deep perineal pouch) 


(removed on opposite side) 



Urethra 


Compressor urethrae 

Vagina 


Perineal body 


internus 


Piriformis 


muscle 

Puborectalis 

Pubococcygeus 

Iliococcygeus 

Anus 

Levator ani 

Muscles of deep perineal pouch in women 

(perineal membrane removed on left side to expose deep perineal pouch) 


sphincter 

Pelvic fascia 

Opening for urethra 

Deep transverse 


Opening for urethra 


Pelvic fascia 

Opening for vagina 




Compressor 

urethrae 



Muscles of deep perineal pouch in men 



Muscles of deep perineal pouch in women 

259

PELVIS AND PERINEUM • Muscles and erectile tissues in men 

Fundiform ligament of penis 


Midline raphe 









Anterior recess of 

ischio-anal fossa 

Pubococcygeus 


Sacrotuberous 

ligament 

Iliococcygeus 


Puborectalis 


Perineal body 

Muscles of the superficial perineal pouch in men 









Anterior recess of 

ischio-anal fossa 

Iliococcygeus 



obturator internus 


Perineal body 

Puborectalis 


Pubococcygeus 


Erectile tissues of the superficial perineal pouch in men 

260

Erectile tissue in men: imaging 

5 











Erectile tissues in relation to other structures in the male perineum. 


Dorsal vein of penis 



Urethra 








Erectile tissues in relation to other structures in the male perineum. 


261

PELVIS AND PERINEUM • Muscles and erectile tissues in women 






Suspensory ligament of clitoris 


Urethra 



Vagina 

Perineal body 

Pubococcygeus 


levator ani) 

Puborectalis 


levator ani) 


Iliococcygeus 


Muscles of the superficial perineal pouch in women 


Body of clitoris 



Urethra 



Vagina 


obturator 

internus 

Perineal body 

Iliococcygeus 


levator ani) 

Piriformis 

Greater vestibular gland 

Puborectalis 


Pubococcygeus 


Sacrotuberous 

ligament 

262 

Erectile tissues of the superficial perineal pouch in women

Erectile tissue in women: imaging 

5 


Vestibule 




Ischium 

Anus 

Ischium 

Erectile tissues in relation to other structures in the female perineum. 


Pubic ramus 


Vagina 

Anus 


Pubic ramus 

Urethra 


Femur 


Erectile tissues in relation to other structures in the female perineum. 


263

PELVIS AND PERINEUM • Internal pudendal artery and vein 




Internal iliac artery and vein 

Superior gluteal artery and vein 


iliac artery 





Obturator artery and vein 



of levator ani 

Anterior trunk of 

internal iliac artery 

and vein 

Piriformis 




Coccygeus 


Levator ani 

Inferior rectal artery and vein 


Dorsal artery of penis 

(dorsal artery of clitoris in women) 



Internal pudendal artery and vein 


Perineal artery and vein 




Testicle in scrotum 

Course of internal pudendal artery and vein in men 


264


5 

L4 

L5 


S1 

S2 

Piriformis 


S3 

S4 


Nerves to coccygeus, 

levator ani, and external 

anal sphincter 




of levator ani 

Levator ani 

Pubococcygeus 


Dorsal nerve of penis 

Coccygeus 


Inferior rectal nerve 

Anal aperture 






Perineal nerve 



Superficial perineal pouch 

Urethra 

Posterior scrotal nerve 


Testicle in scrotum 

Course of pudendal nerve in men 


265

PELVIS AND PERINEUM • Vasculature of perineum 




Deep dorsal artery and vein of penis 









Deep artery of penis 

entering crus 





Transverse branches 

of perineal artery 

and vein 



Artery and vein 

of bulb of penis 







Piriformis 


Levator ani 

Arteries and veins of perineum in men 

(perineal membrane removed on left side to expose deep perineal pouch; inferior view) 



Posterior labial artery and vein 


Dorsal artery and vein of clitoris 




Dorsal artery and vein of clitoris 


Compressor 

urethrae 

Superficial 

transverse 


Perineal artery 

and vein 



Greater vestibular 

gland 




Piriformis 


Levator ani 

266 

Arteries and veins of perineum in women 

(perineal membrane removed on left side to expose deep perineal pouch; inferior view)

Nerves of perineum 

5 

Bulbospongiosus muscle 







Motor branches to muscles of deep pouch 



Posterior scrotal nerve 


Posterior scrotal 

branch of the 

perineal nerve 



Superficial 

transverse 








Piriformis 


Levator ani 

Nerves of the perineum in men 


Motor branches to 

muscles of deep pouch 







Dorsal nerve of clitoris 




Compressor 

urethrae 

Posterior labial 

branch of the 

perineal nerve 

Greater vestibular 

gland 






Piriformis 


Levator ani 

Nerves of the perineum in women 


267

PELVIS AND PERINEUM • Lymphatics of pelvis and perineum in men 

Esophagus 

Diaphragm 

Celiac nodes 

Intestinal trunk 




Superior mesenteric nodes 








Testicular artery and vein 


Lateral sacral node 



Rectum 

Superolateral 

superficial 

inguinal nodes 

Bladder 

Superficial 

circumflex 

iliac vein 

Saphenous ring 

Superomedial 

superficial 


Inferior 

superficial 


Great saphenous 

vein 

Fascia lata 

Presymphyseal node 



(lumbar) nodes 

Psoas major 

Psoas minor 

Middle sacral node 

Left ureter 






Femoral vein 

Deep inguinal nodes 

268 

Lymphatics of pelvis and perineum in men

Lymphatics of pelvis and perineum in women 

5 

Esophagus 

Diaphragm 


Celiac nodes 

Superior mesenteric nodes 










Ovarian artery and vein 





(lumbar) nodes 

Psoas major 

Psoas minor 

Left ureter 

Middle sacral node 



Rectum 

Superolateral 

superficial 


Bladder 

Superficial 

circumflex 

iliac vein 

Saphenous ring 

Superomedial 

superficial 


Inferior 

superficial 


Great saphenous 

vein 







Uterus 

Ovary 



Femoral vein 

Deep inguinal nodes 

Lymphatics of pelvis and perineum in women 

269

PELVIS AND PERINEUM • Lymphatics 




Right internal iliac artery 


Iliacus 




Median sacral node 

Lateral sacral 

artery 


Pubic branch of 

inferior epigastric 




and vein 

Obturator node 



Internal iliac 

nodes 

Median sacral 

artery 

Middle rectal 

artery 


artery 

Coccygeus 




Iliococcygeus 


Puborectalis 


Pubococcygeus 



Lymphatics of pelvic cavity (sagittal view) 

270

Dermatomes 

5 

Dorsal nerve of penis (S3) 

Perineal nerve (S2–S4) 



Cutaneous branches of 

inferior rectal nerves (S4) 

L3 

S3 

L1 

Posterior femoral 


(S1–S3) 

S2 

S3 

L2 

S3 

S4 

S5 



(L2–L3) 

Perineal branch of posterior femoral 

cutaneous nerve (S1–S3) 

Middle cluneal nerves (S1–S3) 

Cutaneous branches of coccygeal plexus (S5) 

Inferior cluneal nerves (S1–S3) 

Superior cluneal nerves (L1–L3) 

Dermatomes and cutaneous nerves of perineum in men 

L3 

L1 

Perineal nerve (S2–S4) 



Cutaneous branches of 

inferior rectal nerves (S4) 



(S1–S3) 

S2 

S3 

S3 

L2 

S4 

S5 



(L2–L3) 

Perineal branch of posterior femoral 

cutaneous nerve (S1–S3) 

Cutaneous branches of coccygeal plexus (S5) 

Middle cluneal nerves (S1–S3) 

Inferior cluneal nerves (S1–S3) 

Superior cluneal nerves (L1–L3) 

Dermatomes and cutaneous nerves of perineum in women 

271

PELVIS AND PERINEUM • Innervation of reproductive system in men 

T10,11 

T11,12 

L1,2 

T10 

T11 

S2,3,4 

Sympathetic to testis 

and epididymis 


from testis 

T10 and T11 dermatomes 

To pelvic plexus 


Hypogastric 

nerves 

Inferior 

hypogastric 

plexus 

Internal urethral sphincter 

- prevents retrograde 

ejaculation into bladder 

(innervated by sympathetics) 


Sacral splanchnic nerve 


General somatic 

afferent from 

external genitalia 

272 

Erectile tissues 

Somatic motor fiber 


- pulsatile emission of semen 

(innervated by somatic efferent) 

Innervation of reproductive system in men 






Somatic efferent 

Somatic afferent

Innervation of reproductive system in women 

5 

T10,11 


T10 

T11 

To ovary 


(pain) 

T12,L1 

S2,3,4 

T10 and T11 dermatomes 

Accompanies ovarian artery 


Pain (visceral afferent) from body 

and fundus of uterus 

Preganglionic 


Ganglion in right pelvic 

plexus on far side of uterus 

Sacral 

splanchnic nerve 

Pain from cervix 

and upper vagina 



(somatic efferent to skeletal muscles of perineum) 

(general somatic afferents from external genitalia) 

Innervation of reproductive system in women 

273

PELVIS AND PERINEUM • Innervation of bladder 

T11,12 

Visceral efferent (parasympathetic and sympathetic) 

innervation of bladder and visceral afferent nerves 

Lesser and least (thoracic) splanchnic nerves 

and lumbar splanchnic nerves 

Sympathetic trunk and ganglion 

S2,3,4 







Somatic efferent 

Anterior root 

Sacral splanchnic nerve 

Sympathetic pelvic 

ganglion 



External urethral sphincter in deep 

perineal pouch 

-Innervated by somatic efferent 

fibers carried in pudendal nerve 


Somatic motor 

274

Pelvic cavity imaging in men 

5 

Corpora cavernosa 


Femur 

A 



Femur 

B 

Corpora cavernosa and 

crura of penis 

Femur 

Corpus spongiosum and 

bulb of penis 

Anus 

C 

A through C – Series of axial images that pass through the pelvic cavity and perineum from inferior to superior 

showing the various structures and their relationships with each other. 

Fat-saturated T2-weighted MR images in axial plane 

275

PELVIS AND PERINEUM • Pelvic cavity imaging in men 






Femur 

Anal canal 

D 


Femur 

Anal canal 

Urethra 


E 


Urethra 

Femur 



Anal canal 

Puborectalis 


F 

276 

D through J – Series of axial images that pass through the pelvic cavity and perineum from inferior to 

superior showing the various structures and their relationships with each other. 

Fat-saturated T2-weighted MR images in axial plane

Pelvic cavity imaging in men 

5 


Prostate 

Femur 



G 



Anal canal 



Femur 

Prostate 


Anal canal 



H 

Femur 

Bladder 

Prostate 


Bladder 

I 

Ischium 

Rectum 

J 

Ischium 

Rectum 

277

PELVIS AND PERINEUM • Pelvic cavity imaging in women 

Sacrum 


Uterus 

Rectum 

Bladder 

Pubis 

A 

Sacrum 


Uterus 

Rectum 

Bladder 

Vagina 

Pubis 

B 


Sacrum 


Uterus 

Rectum 

278 

Bladder 

Pubis 

Anal canal 

C 

Vagina 

A through F – Series of sagittal 

images that pass through the female 

pelvic cavity and perineum showing 

the various structures and their 

relationships with each other. 

T2-weighted MR images in sagittal plane

Pelvic cavity imaging in women 

5 


Sacrum 


Uterus 

Rectum 

Bladder 


Urethra 

Vagina 

Anal canal 

D 


Sacrum 


Rectum 

Uterus 

Cervix 

Bladder 

Vagina 

Pubis 

E 

Sacrum 


Rectum 

Bladder 

Pubis 

F 

279


Bladder 

Bladder Uterus Ilium 

A 


B 


Uterus 


Iliacus 

Ilium 

Acetabulum 


Uterus 

Ilium 

C 

Bladder 

Head of femur Neck of femur D 

Bladder Head of femur Neck of femur 

A through G – Series of coronal images that pass through the pelvic cavity and perineum from 

anterior to posterior showing the various structures and their relationships with each other. 


280


5 


Uterus 


Ilium 



Ilium 

E 

Ischium 


Rectum 


Epiphysial plate 


F 

Rectum 


Ischium 

Sacrum 

Ilium 


Rectum 

G 

281


Crus of clitoris Vestibule 


Vagina Urethra Pubic symphysis 

Femur 

A 


Anus 




(passing through 

lesser sciatic foramen) 

B 

Anus 



Acetabulum 

Vagina 

Bladder 


Vagina 

Bladder 



Anal canal 



Rectum 

Ischium 


C 


D 

A through H – Series of axial images that pass through the pelvic cavity and perineum from 

inferior to superior showing the various structures and their relationships with each other. 

T2-weighted MR images in axial plane 

282


5 

Bladder 

Uterus 


Acetabulum 

Uterus 

Cervix 


E 

Ischium 

Rectum 


F 

Ischium 

Rectum 


Uterus 

Cervix 


Uterus 

Sigmoid colon 

G 

Rectum 

Ilium 

H 

Rectum 

Ilium 

283

PELVIS AND PERINEUM • Tables 

Branches of the sacral plexus 

(spinal segments in parentheses do not consistently participate) 

Branch Spinal segments Motor function Sensory (cutaneous) function 

Tibial part 

1 

L4 to S3 

All muscles in the posterior or 

hamstring compartment of the thigh 

(including the hamstring part of the 

adductor magnus) except for the short 

head of the biceps 

Skin on posterolateral and lateral 

surfaces of foot and sole of foot 

All muscles in the posterior compartment 

of the leg 

All muscles in the sole of the foot 

Common fibular part 

2 

L4 to S2 

Short head of biceps in the posterior 

compartment of the thigh 

Skin on the anterolateral surface of the 

leg and dorsal surface of the foot 

All muscles in the anterior and lateral 

compartments of the leg 

Extensor digitorum brevis in the foot 

(also contributes to the supply of the 

first dorsal interosseous muscle) 

Pudendal 

3 

S2 to S4 

Skeletal muscles in the perineum 

including the external urethral and 

anal sphincters and levator ani 

(overlaps in supply of the levator ani 

and external sphincter with branches 

directly from ventral division of S4) 

Most skin of the perineum, penis and 

clitoris 


4 

L4 to S1 

Gluteus medius, gluteus minimus, 

and tensor fasciae latae 


5 

L5 to S2 


Nerve to obturator 

internus and 

superior gemellus 

6 

L5 to S2 

Obturator internus and superior 

gemellus 

Nerve to quadratus 

femoris and inferior 

gemellus 

7 

L4 to S1 

Quadratus femoris and inferior gemellus 


cutaneous (posterior 

cutaneous nerve of 

thigh) 

8 

S1, S3 

Skin on the posterior aspect of the thigh 

Perforating cutaneous 

9 

S2, S3 

Skin over gluteal fold (overlaps with 

posterior femoral cutaneous) 

Nerve to piriformis 

10 

(L5), S1, S2 

Piriformis muscle 

Nerves to levator ani, 

coccygeus, and 


11 

S4 

Levator ani, coccygeus, and external 

anal sphincter (overlaps with pudendal 

nerve) 

Small patch of skin between anus and 

coccyx 

284

Tables 

5 

Branch 

Spinal segments 

Motor function 

Sensory (cutaneous) function 


nerves 

12 

S2, S3 (S4) 

Visceral motor (preganglionic 

parasympathetic) to pelvic part of 

prevertebral plexus 

Stimulate erection, modulate mobility in 

gastrointestinal system distal to the left 

colic flexure, inhibitory to internal 

urethral sphincter 

Visceral afferents from pelvic viscera 

and distal parts of colon. Pain from 

cervix and possibly from bladder and 

proximal urethra 

Branches of the coccygeal plexus 


13 

S4 to Co 

Peri-anal skin 

L4 

L5 

S1 

4 

S2 

5 

S3 

10 

S4 

8 

9 

S5 

12 

11 

1 

2 

6 

7 

3 

Co 

13 

285

PELVIS AND PERINEUM • Tables 

Muscles of the pelvic walls 

(spinal segments in bold are the major segments innervating the muscle) 



1 

Anterolateral wall of true 

pelvis (deep surface of 

obturator membrane and 

surrounding bone) 

Medial surface of greater 

trochanter of femur 

Nerve to 

obturator 

internus L5, SI 

Lateral rotation of the extended 

hip joint; abduction of flexed 

hip 

Piriformis 

2 

Anterior surface of sacrum 

between anterior sacral 

foramina 

Medial side of superior 

border of greater trochanter 

of femur 

Branches from 

L5, SI, and S2 

Lateral rotation of the extended 

hip joint; abduction of flexed hip 

Muscles of the pelvic diaphragm 

Levator ani 

3 

In a line around the pelvic 

wall beginning on the 

posterior aspect of the pubic 

bone and extending across 

the obturator internus 

muscle as a tendinous arch 

(thickening of the obturator 

internus fascia) to the ischial 

spine 

The anterior part is attached 

to the superior surface of 

the perineal membrane; the 

posterior part meets its 

partner on the other side at 

the perineal body, around 

the anal canal, and along 

the anococcygeal ligament 

Branches direct 

from the anterior 

ramus of S4, and 

by the inferior 

rectal branch of 

the pudendal 

nerve (S2 to S4) 

Contributes to the formation of 

the pelvic floor, which supports 

the pelvic viscera; maintains an 

angle between the rectum and 

anal canal. Reinforces the 

external anal sphincter and, in 

women, functions as a vaginal 

sphincter 

Coccygeus 

4 

Ischial spine and pelvic 

surface of the sacrospinous 

ligament 

Lateral margin of coccyx 

and related border of 

sacrum 

Branches from 

the anterior rami 

of S3 and S4 

Contributes to the formation of 

the pelvic floor, which supports 

the pelvic viscera; pulls coccyx 

forward after defecation 

Muscles within the deep perineal pouch 


sphincter 

5 

From the inferior ramus of 

the pubis on each side and 

adjacent walls of the deep 

perineal pouch 

Surrounds membranous 

part of urethra 

Perineal 

branches of the 

pudendal nerve 

(S2 to S4) 

Compresses the 

membranous urethra; 

relaxes during micturition 


perineal 

6 

Medial aspect of ischial 

ramus 

Perineal body 

Perineal 



(S2 to S4) 

Stabilizes the position of the 

perineal body 

Compressor 

urethrae 

(in women only) 

7 

Ischiopubic ramus on each 

side 

Blends with partner on other 

side anterior to the urethra 

Perineal 



(S2 to S4) 

Functions as an accessory 

sphincter of the urethra 

Sphincter 

urethrovaginalis 

(in women only) 

8 

Perineal body 

Passes forward lateral to 

the vagina to blend with 

partner on other side 

anterior to the urethra 

Perineal 



(S2 to S4) 

Functions as an accessory 

sphincter of the urethra (also 

may facilitate closing the 

vagina) 

286

Tables 

5 

1 

2 

3 

4 

5 

6 

5 

6 

7 

8 

Male 

Female 

287

Tables 

5 

Muscles of the superficial perineal pouch 



1 Ischial tuberosity and 

ramus 

Crus of penis and clitoris 


(S2 to S4) 

Move blood from crura into 

the body of the erect penis 

and clitoris 


2 In women: perineal body 

In men: perineal body, 

midline raphe 

In women: bulb of vestibule, 

perineal membrane, body 

of clitoris, and corpus 

cavernosum 

In men: bulbospongiosus, 

perineal membrane, and 

corpus cavernosum 


(S2 to S4) 

Move blood from attached 

parts of the clitoris and penis 

into the glans 

In men: removal of residual 

urine from urethra after 

urination; pulsatile emission 

of semen during ejaculation 


perineal 

3 Ischial tuberosity and 

ramus 

Perineal body 


(S2 to S4) 

Stabilize the perineal body 

1 

1 

2 

2 

3 

3 

Male 

Female 

289


6 

CONTENTS 

LOWER LIMB 


Bones of the lower limb 293 

Pelvic bones and sacrum 294 

Articulated pelvis 295 

Proximal femur 296 

Hip joint 297 

Hip joint: structure and arterial supply 299 

Gluteal region: attachments and superficial 

musculature 300 

Gluteal region: superficial and deep muscles 301 

Gluteal region: arteries and nerves 302 

Distal femur and proximal tibia and fibula 304 

Thigh: muscle attachments 305 

Thigh: anterior superficial musculature 306 

Thigh: posterior superficial musculature 307 

Thigh: anterior compartment muscles 308 

Thigh: medial compartment muscles 309 

Femoral triangle 310 

Anterior thigh: arteries and nerves 311 

Anterior thigh: arteries 312 

Thigh: posterior compartment muscles 313 

Posterior thigh: arteries and nerves 314 

Transverse sections: thigh 316 

Knee joint 318 

Ligaments of the knee 320 

Menisci and cruciate ligaments 322 

Knee: bursa and capsule 326 

Knee surface: muscles, capsule, and arteries 327 

Popliteal fossa 328 

Tibia and fibula 329 

Bones of the foot 330 

Bones and joints of the foot 333 

Talus and calcaneus 334 

Ankle joint 335 

Ligaments of the ankle joint 336 

Leg: muscle attachments 339 

Posterior leg: superficial muscles 340 

Posterior compartment: deep muscles 341 

Posterior leg: arteries and nerves 342 

Lateral compartment: muscles 343 

Anterior leg: superficial muscles 344 


Anterior leg: arteries and nerves 346 

Leg: cutaneous nerves 347 

Transverse sections: leg 348 

Foot: muscle attachments 350 

Foot: ligaments 351 

Dorsum of foot 353 

Dorsum of foot: arteries and nerves 354 

Plantar aponeurosis 356 

Plantar region (sole) musculature: first layer 357 

Plantar region (sole) musculature: second layer 358 

Plantar region (sole) musculature: third layer 359 

Plantar region (sole) musculature: fourth layer 360 

Plantar region (sole): arteries and nerves 361 

Dorsal hood and tarsal tunnel 363 

Superficial veins of the lower limb 364 

Lymphatics of the lower limb 365 

Anterior cutaneous nerves and dermatomes of 


Posterior cutaneous nerves and dermatomes of 


Tables 368

LOWER LIMB • Surface anatomy 






Scrotum 

Gluteal fold 

Sartorius 






Tendon of semitendinosus 

Patella 




Gastrocnemius 

Gastrocnemius 

Tibia 

Anterior view 



Extensor tendons 

Fifth toe (digit V) 

Fourth toe (digit IV) 

Third toe (digit III) 

Second toe 

(digit II) 


Dorsal venous arch 

Metatarsophalangeal joint 

of great toe 

Great toe (digit I) 

Calcaneal (Achilles) tendon 

Fibularis longus and 

brevis tendons 



292 


Bones of the lower limb 

6 

Pelvic bone 

Pelvic bone 

Pelvis 

Hip 


iliac spine 


iliac spine 

Greater 

trochanter 

Hip joint 

Sacrum 


Hip joint 

Ischial spine 


Intertrochanteric line 

Intertrochanteric crest 

Lesser trochanter 


Coccyx 




Linea aspera 

Thigh 

Anterior view 

Femur 


Knee 


Patella 




Knee joint 






Tibia 

Soleal line 

Fibula 

Leg 

Fibula 

Shaft of tibia 

Tibia 

Ankle 

Foot 


Calcaneus 

Cuboid 

Metatarsal bones 


Ankle joint 

Talus 

Navicular 

Cuneiform bones 



Calcaneus 

Cuboid 

Metatarsals 

Phalanges 

Phalanges 

293 


LOWER LIMB • Pelvic bones and sacrum 


Ala 


LV 






Ala 

Promontory 

Facet for articulation with pelvic bone 

at sacro-iliac joint 

Lumbosacral 

articular surface 

Sacrum 


Transverse ridges 

Promontory 

Anterior sacral 

foramina 

Sacrum (lateral view) 


Coccyx 

Coccygeal cornu 


Coccyx 



Sacral hiatus 

Sacral canal 

Sacral cornua 

Sacrum (posterior view) 

Iliac fossa 

Iliac crest 

Anterior gluteal line 

Anterior 

superior 

iliac spine 

Iliac tuberosity 

Pecten pubis 


Superior 

pubic ramus 

Arcuate line 

Posterior 

superior 

iliac spine 


Articular surface of sacrum 

at sacro-iliac joint 

Ligament 

attachments 

Posterior gluteal line 

Posterior inferior iliac spine 


Acetabulum 

Tubercle of the iliac crest 

Anterior 

superior 

iliac spine 

Inferior 

gluteal line 

Anterior 

inferior 

iliac spine 

Superior pubic 

ramus 

Pubic 

tubercle 

Pubic 

crest 

Inferior pubic ramus Ischial ramus 


Pelvic bone (medial view) 

Lesser sciatic notch 

Ischium 

Ischial spine 

Lesser sciatic notch 

Ilium 

Pubis 

Obturator 

membrane 

Ischial ramus 


Pelvic bone (lateral view) 

Pubic 

tubercle 

Inferior 

pubic 

ramus 

Acetabular 

fossa 


294 


Articulated pelvis 

6 

Iliac crest 

Iliac fossa 



Promontory 

Sacrum 



Ischial spine 


Coccyx 








Femur 



Ischial ramus 

Anterior view 

Iliac crest 





iliac spine 

Sacrum 

Sacral hiatus 


Coccyx 

Ischial spine 





Femur 

Linea aspera 






295 


LOWER LIMB • Proximal femur 

Head 

Head 

Trochanteric fossa 

Fovea 




Neck 

Neck 

Quadrate tubercle 





Head 

Gluteal tuberosity 


Fovea 

Pectineal line (spiral line) 

Shaft 

Shaft 

Neck 



Superior view 

Lateral lip 

Medial lip 

Linea aspera 

Anterior view 


Head 

Head 


Fovea 



Neck 




End of intertrochanteric line 


Pectineal line (spiral line) 

Shaft 

Lateral view 

Medial view 

296 


Hip joint 

6 

Acetabular fossa 

Acetabular labrum 

Ischial spine 



Lunate surface 

(articular) 

Acetabular foramen 

Transverse acetabular ligament 



Acetabular fossa and transverse acetabular ligament 


Cut synovial 

membrane 


Ilium 

Cut synovial membrane 

Posterior branch of obturator artery 

Femur 

Acetabular branch of 

obturator artery 

Artery of ligament of head 

Anterior branch of obturator artery 

Ligament of the femoral head 

Synovial sleeve around ligament 

Ligament of head of femur. 

The head of the femur has been laterally rotated 


Artery of ligament of head 

Sacrum 

Pubis 


Ischium 



Anterior branch 

Acetabular branch 

Posterior branch 



Normal hip joint. 


Obturator artery and branches 

297 


LOWER LIMB • Hip joint 

Acetabular roof 

Acetabular labrum 

Ligaments and joint capsule 

Synovial membrane 



Ligament of head of femur 

Acetabular fossa 

Epiphyseal plate 


Transverse acetabular 

ligament 


Zona orbicularis 


Coronal section through hip joint 

Body of LIV vertebra 

Ilium 

Acetabulum 






Hip joints. 

CT image in coronal plane 

298 


Hip joint: structure and arterial supply 

6 


Line of attachment 

around head of femur 

of synovial membrane 


Fibrous membrane 


(inner circular 

fibers of fibrous 

membrane) 



reflects back to 

attach to margin of 

acetabulum 


(inner circular 

fibers of fibrous 

membrane) 

Pubofemoral ligament 


Joint capsule and synovial membrane 

Ischial spine 



Ischiofemoral ligament 

Femur 

Ischiofemoral ligament (posterior view) 







Intertrochanteric 

crest 



iliac spine 



Greater 

trochanter 

Deep circumflex 

iliac artery 

Superficial 

circumflex 

iliac artery 

Superficial 


Ascending 


lateral circumflex 

femoral artery 

Intertrochanteric 

line 

Femur 

Pubofemoral ligament 


Iliofemoral and pubofemoral ligaments (anterior view) 

Transverse branch 

of lateral circumflex 


Medial circumflex 




First perforating artery 



Arterial supply of the hip joint 

Superficial 

external 

pudendal artery 


obturator artery and 

acetabular branch 

Deep external pudendal artery 

299 


LOWER LIMB • Gluteal region: attachments and superficial musculature 

Iliac crest 



iliac spine 

Iliac crest 

Gluteal 

region 

Gluteal fold 



Sartorius 

Tensor fasciae 

latae 

Rectus 

femoris 

Surface anatomy of the gluteal region 





Gluteus minimus 



Sartorius 








Short head of 

biceps femoris 



Patella 

Obturator 

internus 

Adductor 

magnus 


Long head of 


and semitendinosus 

Iliopsoas 

Gluteus maximus Head of fibula 



Gastrocnemius (lateral head) 


Muscle attachments of the gluteal region 

300 

Muscles of the hip and thigh (lateral view) 


Gluteal region: superficial and deep muscles 

6 

Iliac crest 



Gluteus medius (cut) 




above piriformis 

Attachment of gluteus 

maximus to iliotibial tract 




Gracilis 



Piriformis 

Superficial muscles of the gluteal region 


Body of LIV vertebra 


below piriformis 





Obturator 

internus 

Ilium 



Acetabulum 






Femur 




Deep muscles of the gluteal region 


Positioning of gluteus medius and minimus 

muscles in relation to the hip joint. 


301 


LOWER LIMB • Gluteal region: arteries and nerves 

Medial cluneal nerves (posterior rami of S1–S3) 

Gluteus maximus (cut) 

Superior gluteal artery and vein 

Superficial branch of superior gluteal artery 

Gluteus medius (cut) 


Deep branch of superior gluteal artery 



Inferior gluteal artery and vein 

Piriformis 

Lateral circumflex femoral artery (ascending branch) 


Nerve to obturator internus 

Internal pudendal vessels and pudendal nerve 



Medial circumflex femoral artery 

Sciatic nerve 

Gluteus maximus (cut) 

Perforating 






First perforating artery from 

deep artery of thigh 

Piriformis 



Gluteal fold 

Sciatic nerve 

Femur 

Arteries and nerves of the gluteal region 

302 

Sciatic nerve in the gluteal region 

as it relates to the surface 



Gluteal region: arteries and nerves 

6 



superior gluteal artery 

L1 anterior ramus 


Deep branch of 

superior gluteal artery 


Piriformis 



Internal pudendal artery 







Sacrospinous 

ligament 

Sacrotuberous 

ligament 

Lateral circumflex 





Femoral branch 

of genitofemoral nerve 



Nerves to quadratus femoris 

and obturator internus 

S1 

S2 

S3 

First perforating artery 

Femur 

Arteries of the gluteal region 

Femoral nerve 

Perforating 

cutaneous 

nerve 



Sciatic nerve 

Branches of the lumbosacral plexus related to lower limb 

303 


LOWER LIMB • Distal femur and proximal tibia and fibula 

Lateral view 

Anterior view 


Medial view 

Medial supracondylar line 

Lateral 

supracondylar 

line 

Lateral 

epicondyle 

Intercondylar line 

Adductor tubercle 

Medial 

epicondyle 

Popliteal surface 

Medial 

epicondyle 

Lateral 

epicondyle 

Adductor 

tubercle 

Superior articular surface 

(lateral facet) 

Lateral 

femoral 

condyle 

Patellar surface 

Intercondylar eminence 

Medial 

femoral 

condyle 

Intercondylar fossa 

Distal end of (right) femur 

Intercondylar tubercles 

Lateral 

femoral 

condyle 

Medial femoral condyle 


(medial facet) 

Lateral tibial 

condyle 

Anterior 

intercondylar area 



proximal head of 

fibula 

Anterior border 

Medial tibial 

condyle 

Posterior 

intercondylar area 

Medial surface 

Soleal line 

Medial border 


condyle 

Tibial 

tuberosity 


proximal head of 

fibula 

Medial tibial 

condyle 

Lateral surface 

Interosseous border 

Posterior surface 

Interosseous 

border 

Lateral view 

Base 

Anterior view 


Proximal end of (right) tibia 

Styloid process 

Base 

Anterior surface 

Head 

Neck 


inferior surface 

of lateral condyle 

of tibia 

Medial view 


Head 

Neck 

Lateral 

border 

Medial 

border 

Articular surface 

Medial crest 

304 

Apex 

Anterior view 


Apex 

Inferior view 

Patella (right) 


Medial border 

Apex 

Shaft 



Anterior view 

Medial part of 

posterior surface 


Interosseus 

border 


Proximal end of (right) fibula 

Shaft 



Thigh: muscle attachments 

6 


Iliacus 


Sartorius 

Piriformis 



Piriformis 




Iliopsoas 



Gracilis Gemellus inferior 

Obturator Adductor brevis 


externus 

Long head of biceps 


Pectineus 

femoris and semitendinosus 





Sartorius 






Iliopsoas 

Pectineus 




Vastus intermedius 



Muscle attachments of the pelvis and thigh 




Articularis genus 


Gastrocnemius 

(medial head) 

Plantaris 


Popliteus 



Biceps femoris 

Quadriceps femoris 

via patellar ligament 

Gracilis 

Sartorius 


Popliteus 

Pes anserinus 

Origins 

Insertions 

Anterior view 


305 


LOWER LIMB • Thigh: anterior superficial musculature 



Psoas 

Iliacus 

Pectineus 



Posterior 

compartment 

of thigh 

Sartorius 

Gracilis 


Anterior 

compartment 



Medial 

compartment 



Surface anatomy of lower limb 

with overlay of muscles 


Patella 

Superficial muscles of the thigh (anterior view) 

306 


Thigh: posterior superficial musculature 

6 



Gluteus 

maximus 

Adductor 

magnus 

Anterior 

compartment 





Medial 

compartment 



Gracilis 


Posterior 

compartment 





Sartorius 

Plantaris 

Gastrocnemius 

Surface anatomy of lower limb 



Superficial muscles of the thigh (posterior view) 

307 


LOWER LIMB • Thigh: anterior compartment muscles 

Iliacus 

LI 

Sartorius 


Psoas 



Iliopsoas 

Sartorius (cut) 

Iliopsoas (cut) 

Iliacus 

Sartorius 


Obturator 

externus 



Sartorius (cut) 

Vastus 

intermedius 



Quadriceps 

femoris via 

patellar 

ligament 


Sartorius 


Quadriceps femoris tendon 

Patella 

Fibular collateral ligament 

Vastus 

intermedius 

Muscle attachments of the anterior 


Patellar ligament 

Sartorius tendon 

Patella 

Anterior compartment 


Tibial collateral ligament 

Posterior compartment 

308 

Medial 

compartment 

Superficial muscles of the anterior 


Deep muscles of the anterior 



Thigh: medial compartment muscles 

6 

Gracilis 

Pectineus 







Ligaments of 

hip joint 

Pectineus 

Ligaments of 

hip joint 



Gracilis 

Adductor 

magnus 

Pectineus 




Openings for 

perforating branches 

of deep artery of 

thigh 


Gracilis 

Femur 

Femur 


Adductor hiatus 


Adductor magnus tendon 

Muscle attachments of the medial 



Patella 


Anterior 

compartment 

Fibula 

Gracilis tendon 

Posterior 

compartment 

Tibia 

Medial 

compartment 

Superficial muscles of the medial 


Deep muscles of the medial 


309 


LOWER LIMB • Femoral triangle 

Psoas 

Femoral canal (medial compartment Iliacus 

of femoral sheath containing 

lymphatic vessels and nodes 


Iliacus 

Boundaries of the 

femoral triangle 

Femoral nerve 

Femoral sheath 



(base of femoral 

triangle) 

Iliacus 

Psoas 

Pectineus 

Medial margin 

of sartorius 

(lateral border 

of femoral 

triangle) 

Medial margin 

of adductor 

longus (medial 

border of 

femoral 

triangle) 

Inguinal 

ligament 

Gracilis 

Femoral sheath, 

continuous with the 

transversalis fascia (anterior) 

and iliac fascia (posterior) 

of the abdominal cavity 



Femoral nerve 

Lymphatics in 

femoral canal 

Great 

saphenous 

vein 

Adductor canal 

Deep inguinal 

nodes in femoral 

canal 

Pectineus 


Femoral vein 


Gracilis 




and vein passing 

through hiatus 


Sartorius 

Contents of the femoral triangle 

310 

Adductor canal

Anterior thigh: arteries and nerves 

6 

Psoas major 


Femoral nerve 


Iliacus 

Pectinus (cut) 

Femoral nerve 




Nerve to sartorius 

Nerve to pectineus 



Anterior femoral 

cutaneous nerves 

Obturator 

nerve 

Pectineus 



Gracilis 

Piriformis 

Ascending branch of 



Transverse branch 




obturator nerve 




Descending branch 




Muscular branches of 

femoral nerve 

Muscular branches 

of obturator nerve 


Terminal end of 




Cut edge of fascia 


Femoral artery passing 

through adductor hiatus 

Branch of anterior femoral 


Saphenous branch 

of descending 

genicular artery 

Articular branch 





Saphenous branch 



Circumflex fibular branch 

of posterior tibial artery 


Superficial arteries and nerves of the thigh (anterior view) 

Deep arteries and nerves of the thigh (anterior view) 

311

LOWER LIMB • Anterior thigh: arteries 





Superficial circumflex iliac artery 





Ascending branch of lateral 


Superficial external pudendal artery 

Transverse branch of lateral 


Superficial 



Medial circumflex femoral artery 

First perforating artery from deep 

artery of thigh 

Second perforating artery 

Third perforating artery 

Deep external pudendal artery 





Ascending 

branch 

Transverse 

branch 

Descending 

branch 

Terminal end of 




Femur 

Descending genicular artery 

Saphenous branch of descending 


Articular branch of descending 





Superior lateral genicular artery 

Superior medial genicular artery 

Inferior lateral genicular artery 



Fibula 

Inferior medial genicular artery 

Anterior tibial recurrent artery 

Tibia 


312 

Arteries of the thigh (anterior view)

Thigh: posterior compartment muscles 

6 





biceps femoris and 

semitendinosus 














Muscle attachments of the posterior 


Oblique popliteal ligament 

Anterior 

compartment 

Semimembranosus tendon 


Semitendinosus tendon 

Medial 

compartment 

Posterior 

compartment 

Superficial muscles of the posterior 


Deep muscles of the posterior 


313

LOWER LIMB • Posterior thigh: arteries and nerves 





Deep branch 

of superior 

gluteal artery 


artery 

Posterior 

cutaneous 


Obturator 

internus 

Inferior cluneal 

nerves 

Perineal branches 


Deep branch of superior 



Piriformis 





Sciatic nerve 




Femur 


Piriformis 



First perforating 

artery from deep 

artery of thigh 

Femur 

Second perforating 

artery 



Muscular branches 

of sciatic nerve 


Third perforating 

artery 

Descending branch 



Terminal end 





Long head of biceps femoris (cut) 





biceps femoris (cut) 





Sural arteries 

Tibial nerve 

Inferior lateral 



Inferior medial 





Circumflex fibular 

branch 


Tibia 

Fibula 


314 

Arteries and nerves of the thigh (posterior view) 

Deep arteries of the thigh (posterior view)

Posterior thigh: arteries and nerves 

6 


Deep branch of superior 








Perineal branches of posterior 

cutaneous nerve of thigh 

Sciatic nerve 

Femur 










Femur 

Third perforating artery 

Muscular branches of sciatic nerve 

Terminal end 





Sural nerve 

Tibial nerve 

Descending genicular artery 

Articular branch of descending 


Saphenous branch of descending 




to gastrocnemius 


Superior lateral genicular artery 


Inferior lateral genicular artery 

Fibula 

Tibia 



Fibula 

Tibia 

Nerves of the thigh (posterior view) 

Arteries of the thigh (posterior view) 

315

LOWER LIMB • Transverse sections: thigh 


Deep artery and vein of thigh 



Iliopsoas 



Branches of femoral nerve 

Sartorius 




Obturator nerve (anterior branch) 

Pectineus 


Obturator nerve (posterior branch) 

Gracilis 


Femur 

Fascia lata 



A 

Sciatic nerve 







Sartorius 

Nerve to vastus medialis 


A 

Femur 




and vein 

B 



Gracilis 

Deep artery and vein of thigh 







Sciatic nerve 

B 

Rectus femoris tendon 

Articularis genus 

C 


Femur 



Adductor magnus tendon 

Sartorius 

Popliteal artery and vein 


316 



Tibial nerve 

C 



Gracilis 

Transverse sections through thigh 

Semimembranosus

Transverse sections: thigh 

6 

Sartorius 





Femur 




Pectineus 


Gracilis 





A 




Femur 



Sartorius 




Gracilis 





B 

Rectus femoris tendon 


Femur 



Popliteal vessels 




Sartorius 

Gracilis 


C 

Transverse/axial sections through the thigh. 

A. Proximal/upper thigh. T1-weighted MR image in axial plane 

B. Middle thigh. T1-weighted MR image in axial plane 

C. Distal/lower thigh. Fat-saturated T2-weighted MR image in axial plane 

317

LOWER LIMB • Knee joint 

Femur 

Femur 

Popliteal surface 


Intercondylar 

fossa 



Patella 


condyle 


condyle 

Proximal 

tibiofibular joint 



Medial tibial condyle 

Intercondylar 

eminence 


condyle 


condyle 

Proximal 



Neck of fibula 


Patella 

Tibia 


Fibula 

Tibia 

Surface for articulation 

with patella 

Fibula 

Anterior view 


Femur 



Femur 


Superior view 



Patella 

Patella 








Proximal 



Tibia 

Fibula 

Fibula 

Tibia 

Medial view 

Lateral view 

318

Knee joint 

6 

Femur 



Lateral femoral condyle 

Lateral tibial condyle 


Medial tibial condyle 




Tibia 

Fibula 

Normal knee joint. 


Femur 

Patella 



Tibia 

Fibula 



319

LOWER LIMB • Ligaments of the knee 

Femur 

Femur 


tendon 




Patella 

Popliteus tendon 

Lateral meniscus 

Fibular collateral 

ligament 



Medial femoral 

condyle 

Medial meniscus 

Medial tibial 

condyle 


tendon 

Oblique popliteal 

ligament 


ligament 

Popliteus (cut) 


Proximal 



Joint capsule 

Proximal 


Interosseous 

membrane 

Opening for anterior 

tibial vessels 

Opening for anterior 


Fibula 

Tibia 

Tibia 

Fibula 

Anterior view 


Femur 

Femur 

Quadriceps 

femoris tendon 

Quadriceps 




Patella 

Patella 



Attaches to medial 

meniscus 



ligament 





Proximal 



Tibia Fibula 

Fibula Tibia 

Medial view 

Lateral view 

320

Ligaments of the knee 

6 


Femur 


Patella 


Tibia 

Fibula 

Lateral head of gastrocnemius 



Anterior 

Posterior 


ligament 

Tendon of biceps 

femoris 


Unique view showing the fibular collateral ligament and the 

tendon of the biceps femoris muscle attaching to the head of the fibula. 


321

LOWER LIMB • Menisci and cruciate ligaments 


Posterior cruciate ligament 


Popliteus 

tendon 


condyle 

Medial femoral 

condyle 

Popliteus 

tendon 


condyle 

Tibial collateral 

ligament 



Tibia 


Coronal view of knee joint showing the fibular collateral 

ligament and its relationship to surrounding structures. 


Anterior cruciate ligament 



Tibia 

Anterior view of knee joint showing the relationship between 

the tibial collateral ligament and the medial meniscus. 


Femur 

Anterior cruciate 

ligament 


condyle 



condyle 

Posterior cruciate 

ligament 



Medial tibial 

condyle 

Transverse 

ligament 


ligament 

Intercondylar 

fossa 

Anterior cruciate 

ligament 


condyle 


Posterior 

meniscofemoral 

ligament 

Fibula 

Tibia 

Tibia 

Fibula 

322 

Anterior view (flexed) 

Posterior view

Menisci and cruciate ligaments 

6 


Attachment of anterior 

cruciate ligament 

Attachments of 

medial meniscus 

Attachments of 

lateral meniscus 

Transverse ligament 



of tibia (lateral facet) 




of tibia (medial facet) 

Attachment of posterior 

cruciate ligament 

Attachment of synovial 

membrane 


Posterior meniscofemoral ligament 

Attachments of menisci, cruciate ligaments, and 

synovial membrane of the right tibia. 


Menisci of the right knee joint. 


Femur 







Tibia 

Anterior view of knee joint showing the anterior and posterior cruciate ligaments. 


323

LOWER LIMB • Menisci and cruciate ligaments 


tendon 

Femur 

Patella 



Tibia 


Femur 

Patella 




Tibia 

Femur 



Tibia 

324 

A series of images moving from medial to lateral showing the relationship 

between anterior and posterior cruciate ligaments. 

T2-weighted MR images in sagittal plane

Menisci and cruciate ligaments 

6 


Femur 

Suprapatellar bursa 


Synovial membrane of joint capsule 


of joint capsule 



Infrapatellar fold 


Subpopliteal recess 


Posterior 

meniscofemoral ligament 
















Iliotibial tract blended into fibrous 

membrane of joint capsule 





Fibrous membrane of joint capsule 

Infrapatellar fat 

Alar fold 

Infrapatellar fold 

Fibula 


Tibia 

Knee joint (anterosuperior view) 

325

LOWER LIMB • Knee: bursa and capsule 

Lateral head of 

gastrocnemius (cut) 

Subtendinous bursa 




ligament 

Proximal 


Femur 


tendon 

Suprapatellar 

bursa 

Prepatellar bursa 


Patellar 


ligament bursa deep to tendon 

Superficial 

infrapatellar bursa Medial meniscus 

Deep 

infrapatellar bursa 



Medial head of 

gastrocnemius (cut) and 

subtendinous bursa 



ligament 



and subtendinous 

bursa 


ligament 




Proximal 



Fibula 

Interosseous 

membrane 

Tibia 

Tibia 

Fibula 

Interosseous membrane 

Lateral view 



tendon 

Suprapatellar fat 

Suprapatellar bursa 

Articulus genus 

Femur 

Femur 


Lateral subtendinous bursa 

of gastrocnemius 



Articular cartilage 

Prepatellar bursa 

Patella 

Articular cavity 


Superficial 


Deep 


Infrapatellar fat 


Joint capsule 





ligament and inferior 

subtendinous bursa 

Proximal tibiofibular joint 

Tibial 

collateral 

ligament 

Medial 

meniscus 

Anterior 

cruciate 

Bursa deep to 

tibial collateral 

ligament 

Fibula 

Tibia 

Tibia 

326 

Paramedian section through knee joint 

Coronal section through knee joint (anterior view)

Knee surface: muscles, capsule, and arteries 

6 

Surface anatomy 


Femur 


Vastus intermedius tendon 


Lateral 

Medial 


Patella 





Vastus 

lateralis 

Iliotibial 

tract 

Lateral patellar 

retinaculum 

Fibular 

collateral 

ligament 


tendon (cut) 







Patella 

Descending branch of 



Medial patellar retinaculum 


tendon (cut) 

Gracilis tendon (cut) 



Sartorius tendon (cut) 

Adductor 

hiatus 

Descending 


Saphenous 


descending 


Superior medial 


Popliteal 

artery 


Circumflex 

fibular artery 




Recurrent branch 

of anterior tibial artery 

Fibula 

Tibia 



Posterior 

tibial artery 

Knee joint capsule and related structures 


Anastomoses of arteries around the knee 


327

LOWER LIMB • Popliteal fossa 



Biceps femoris (long head) 

Medial 


Lateral 




ligament 


tendon (cut) 

Plantaris (cut) 

Lateral head of gastrocnemius (cut) 


Oblique popliteal ligament 

Biceps femoris tendon (cut) 


gastrocnemius 


gastrocnemius 

Popliteus 




Femoral vein 

Sciatic nerve 

Linea aspera 

Soleus 



Plantaris 

tendon (cut) 


Biceps femoris (short head) 

Floor of the popliteal fossa 

Biceps femoris (long head) 

Deep fascia 



gastrocnemius 

Sural nerve 

Tibial nerve 



Plantaris 

Small saphenous vein (cut) 

Lateral head of gastrocnemius 




Sural communicating nerve (cut) 


Lateral sural nerve 

Structures in the popliteal fossa 

Superficial structures 

328

Tibia and fibula 

6 

Styloid 

process 

Head 

of fibula 


with tibia 



Tubercles of intercondylar eminence 


Capsule of proximal 


Neck 




with fibula 

Soleal line 

Aperture for anterior 


Lateral 

surface 


Shaft 


Shaft of tibia 


Lateral 

surface 



Groove for tendon 

of tibialis posterior 

Aperture for perforating 

branch of fibular artery 

Anterior tibiofibular ligament 

Lateral 

malleolus 


Malleolar fossa 


Groove for fibularis longus 

Anterior view Posterior view Anterior view 

Articular surface of 

lateral malleolus 

Fibula 

Inferior articular 

surface 

Tibia 









Tibia 

Medial 

surface 

Lateral 

malleolus 

Malleolar fossa 

Fibula 


Articular surface of Superior articular surface 


medial malleolus 



Posterior border 



Posterior 

border 



Medial crest 


Distal tibia and fibula (inferior view) Proximal tibia and fibula (superior view) Cross section through shafts 

329

LOWER LIMB • Bones of the foot 

Digit I 

(great toe) 

Digit II 

Digit III 

Distal phalanx 

Middle phalanx 

Phalanges 

Proximal phalanx 

Digit IV 

Phalanges 

Digit V 

(litte toe) 

Metatarsals 

I 

II 

III 

IV 

IV 

III 

II 

I 

Metatarsal 

bones 

V 

V 

Medial cuneiform 

Intermediate 

cuneiform 

Navicular 

Neck of talus 

Lateral cuneiform 

Groove for tendon 

of fibularis longus 

Cuboid 

Tuberosity of cuboid 

Calcaneal tubercle 


Intermediate 

cuneiform 

Tuberosity of 

navicular 

Head of talus 

Talus 

Sustentaculum tali 

Fibular trochlea 

Calcaneus 


Dorsal view 

Plantar view 

330

Bones of the foot 

6 

Neck of talus 

Navicular 

Talus 


Intermediate cuneiform 

Metatarsals 

Phalanges 

II 

I 

IV 

V 

Sesamoid bone 

Cuboid 

Medial longitudinal arch 

Head of talus 

Medial view 

Groove for tendon of flexor hallucis longus 


Calcaneus 

Talus 

Tarsal sinus 

Navicular 



Calcaneus 

Metatarsals 

II 

III 

IV 

V 

Phalanges 



Lateral longitudinal arch 

Tuberosity of fifth metatarsal bone 

Groove for tendon of fibularis longus 

Cuboid 

Lateral view 

Talus 

Navicular 

Cuneiform bones 

Cuboid 

First metatarsal bone 

Fifth metatarsal bone 

Calcaneus 

Transverse arch 

Cross section through the foot bones 

331

LOWER LIMB • Bones of the foot 

Digit I 

First 

distal 

phalanx 

Digit II 

Tuberosity 

Base 

Digit III 

Head 

First 

proximal 

phalanx 

Base 

Head 

Shaft 

Digit IV 

Base 

Digit V 

Distal phalanges 

Fifth distal phalanx 

Middle phalanges 

Proximal phalanges 

Fifth middle phalanx 

Sesamoids 

First 

metatarsal 

I 

II 

Fifth proximal phalanx 

Head of metatarsal 

A 

B 

Metatarsals 

Medial 

cuneiform 

III 

IV 

V 

Shaft of metatarsal 

Intermediate 

tarsal bone 

C 

D 

Distal group of 

tarsal bones 

Intermediate 

cuneiform 

Base of metatarsal 

Posterior group of 

tarsal bones 

Navicular 

Lateral 

cuneiform 


Intermediate cuneiform Medial cuneiform 

First metatarsal 

Fifth metatarsal 


Talus 

Cuboid 

Cuboid 

A Anterior view 


B Posterior view 

Cuneiforms 

Calcaneus 

Calcaneus with 


for cuboid 

Bones of the foot (dorsal view) 

Head of talus with 


for navicular 

Navicular 

Cuboid 

C Anterior view 

D Posterior view 

332

Bones and joints of the foot 

6 

Metatarsals 

Medial cuneiform Navicular Talus 

Tibia 

Fibula 

Phalanges 

Sesamoid bone 

Tuberosity of fifth 

metatarsal bone 

Foot bones. 


Cuboid 


Calcaneus 

Interphalangeal joints 

Metatarsophalangeal joints 

Talocalcaneonavicular joint 

Calcaneocuboid joint 

Transverse tarsal joint 

Tarsometatarsal joints 

B 

Subtalar joint 



Navicular 

Talocalcaneo-navicular 

joint 

Cuboid 



A 

Talus 

Subtalar joint 

C 



Talocalcaneonavicular joint 

Calcaneus 



Intertasal joints: A. Dorsal view (talus drawn as transparent) B. Lateral view C. Medial view 

333

LOWER LIMB • Talus and calcaneus 

Head 

Neck 

Anterior calcaneal surface 


for navicular 


for medial malleolus 

Articular surface with 

distal end of tibia 

Medial tubercle 

A 

Groove for flexor 

hallucis longus 

Lateral tubercle 


for distal end of tibia 

Neck 


for lateral malleolus 

Sulcus tali 

Posterior calcaneal surface 

Neck 

B 

Articular surface for 

distal end of tibia 

Articular surface for 

calcaneonavicular 

ligament 

Middle calcaneal 

surface 




for lateral malleolus 

Posterior process 

C 

Posterior calcaneal surface 

Lateral process 

Sulcus tali 


for navicular 

Talus: A. Superior view B. Inferior view C. Lateral view D. Medial view 

Anterior talar articular surface 

D 



for medial malleolus 

Lateral tubercle 



Posterior process 


cuboid bone 

Middle talar 





Posterior talar articular surface 

Notch 


Groove for tendon of flexor 


Medial process 

Upper part of 


Posterior talar 


A 

Middle part of posterior surface 

(insertion of calcaneal tendon) 

Calcaneal sulcus 

Middle talar articular surface 

Anterior talar articular surface 

B 


(lower part of posterior surface) 

Posterior talar 



cuboid bone 

334 

C 



Attachment of calcaneofibular part of lateral 

collateral ligament of ankle joint 

Calcaneus: A. Superior view B. Inferior view C. Lateral view D. Medial view 

D 



Medial process

Ankle joint 

6 

Fibula 

Tibia 

Tibia 

Fibula 


Lateral 

malleolus 

Navicular 

Talus 


Malleolar 

fossa 

Lateral 

malleolus 

Cuboid 

Calcaneus 





Anterior view 

(metatarsals and phalanges removed) 


Cuneiforms 

Navicular 

Tibia 

Fibula 

Tibia 


Talus 


Medial 

malleolus 

Talus 

Cuboid 

Calcaneus 


Normal ankle joint. 


Normal ankle joint. 


335

LOWER LIMB • Ligaments of the ankle joint 

Fibula 

Tibia 

Anterior tibiofibular ligament 

Posterior tibiofibular ligament 

Posterior talofibular ligament 

Anterior talofibular ligament 

Lateral ligament of the ankle joint 


Calcaneofibular ligament 

Dorsal talonavicular ligament 

Interosseous talonavicular ligament 

Superior fibular 

retinaculum 

Bifurcate ligament 

Inferior fibular retinaculum 

is attached to fibular 

trochlea between fibularis 

brevis and longus tendons 

Lateral talocalcaneal ligament 

Fibularis longus tendon 

Fibularis brevis tendon 

Long plantar ligament 

Lateral view 

Tibia 

Medial ligament (deltoid ligament) 

of the ankle joint 

Posterior tibiotalar part 

Tibiocalcaneal part 

Tibionavicular part 

Anterior tibiotalar part 

Posterior tibiofibular ligament 



Medial tubercle of talus 

Posterior talocalcaneal ligament 

Medial talocalcaneal 

ligament 

Calcaneus 

Medial view 

Tuberosity of navicular 

Plantar calcaneonavicular ligament 


336

Ligaments of the ankle joint 

6 

Interosseous 

membrane 

Hiatus for 

perforating 


fibular artery 

Fibula 

Anterior 

tibiofibular 

ligament 


Fibula 

Tibia 



Tibia 

Medial 

malleolus 

Medial 

ligament 

Talus 

Lateral 

malleolus 

Anterior talofibular 

ligament 

Calcaneofibular 

ligament 

Lateral 

talocalcaneal 

ligament 

Calcaneus 

Talus 

Tibionavicular part of 

medial ligament 

Posterior talofibular 

ligament 

Anterior tibiotalar part of 



Interosseous talonavicular 

ligament 

Calcaneus 

Coronal section through ankle joint (anterior view) 


Calcaneonavicular 

ligament 

Calcaneocuboid 

ligament 

Interosseous 

membrane 

Bifurcate 

ligament 

Medial 

malleolus 

Tibia 

Fibula 

Posterior 

tibiofibular 

ligament 

Posterior talofibular 

ligament 

Anterior view 

Posterior tibiotalar part of 


Talus 

Posterior 

talofibular 

ligament 

Malleolar 

fossa 

Lateral 

malleolus 

Tibiocalcaneal part of 


Medial talocalcaneal 

ligament 



Lateral 

malleolus 


ligament 

Fibularis brevis 

tendon 


tendon 

Talus 

Calcaneus 

Superior fibular 

retinaculum 

Posterior talocalcaneal 

ligament 

Transverse section through ankle joint (superior view) 


337

LOWER LIMB • Ligaments of the ankle joint 

Fibula 

Tibia 

Fibula 


Talus 


Medial ligament of 

ankle joint 

(deltoid ligament) 

Posterior talofibular ligament 

Calcaneofibular ligament 

Calcaneus 

Coronal view of the ankle joint showing the medial 

ligament of the ankle joint (deltoid ligament). 


Coronal view of the ankle joint showing the 

posterior talofibular and calcaneofibular ligaments. 


Tibia 



Talus 



tendon 

Coronal view of the ankle joint showing 

the flexor hallucis longus passing 

inferior to the sustentaculum tali. 


Calcaneus 

338

Leg: muscle attachments 

6 

Gastrocnemius (medial head) 

Plantaris 


Popliteus 




Gracilis 


(quadriceps femoris) 

Sartorius 


Pes anserinus 

Popliteus 

Soleus 


Soleus 



Tibialis posterior 






Fibularis tertius 

Soleus and gastrocnemius 

via calcaneal tendon 








Origins 

Insertions 


Anterior view 




339

LOWER LIMB • Posterior leg: superficial muscles 





Gracilis 







Femur 


Gastrocnemius 

Sartorius 

Plantaris 

Gastrocnemius 

(lateral head) 

Gastrocnemius 

(medial head) 


Medial 

Lateral 


Soleus 


Plantaris tendon 


Surface anatomy of leg 




Tibial 




Tibialis posterior tendon 

Flexor digitorum longus tendon 


Flexor hallucis longus tendon 


Fibula 


Lateral 

compartment 



340 

Superficial muscles of leg 


Superficial muscles of the posterior 

compartment of leg

Posterior compartment: deep muscles 

6 

Plantaris 

Popliteus 

Popliteus 

Soleus 













Deep muscles of the posterior compartment of leg 

341

LOWER LIMB • Posterior leg: arteries and nerves 




Tibial nerve 





Femur 





Plantaris 





Sural nerve 

Popliteus 



Tibia 



Fibula 

Soleus 










Tibial nerve 


Perforating branch 

of fibular artery 



Communicating branch 


Posterior medial 

malleolar branch of 

posterior tibial artery 



Medial calcaneal nerve 

Lateral calcaneal branch 


Medial calcaneal branch 


Posterior lateral malleolar 


Lateral calcaneal 


342 

Arteries and nerves of leg (posterior view) 

Arteries of leg (posterior view)

Lateral compartment: muscles 

6 


Biceps femoris (short head) 




Patella 



tendon 




(short head) 

Quadriceps 

femoris 

tendon 

Lateral intercondylar 

tubercle 


Head of 

fibula 

Gastrocnemius 



longus 


Patella 


Interosseous 

membrane 





Gastrocnemius 






longus 

Tibia 


(deep fibular nerve) 

Soleus 

Lateral compartment 

(superficial fibular nerve) 





Tibialis anterior tendon 

Extensor hallucis 

longus tendon 


longus tendon 





Muscles of the lateral compartment of leg 



(tibial nerve) 

343

LOWER LIMB • Anterior leg: superficial muscles 







Patella 

Sartorius 

Quadriceps 


Patella 







Gastrocnemius 

Tibia 


Gastrocnemius 

Soleus 




Soleus 


longus 

Lateral 

Medial 


Tibia 






Superior extensor retinaculum 

Lateral 

compartment 


Inferior extensor retinaculum 


longus tendon 



longus tendon 



Superficial muscles of leg 


344

Anterior compartment: muscles 

6 




Oblique line 






Interosseous 

membrane 



Fibula 




Tibia 


Interosseous 

membrane 




longus tendon 




Muscle attachments of the 

anterior compartment of leg 



longus tendon 

Superficial muscles of the anterior 

compartment of leg 

Deep muscles of the anterior 

compartment of leg 

345

LOWER LIMB • Anterior leg: arteries and nerves 


Fibularis longus (cut) 



Fibularis longus (cut) 


Gastrocnemius 






Recurrent branch of anterior 

tibial artery 





Recurrent branch of 

anterior tibial artery 


Extensor 

digitorum longus 

Soleus 

Fibula 

Tibia 


Tibia 






longus tendon 


deep fibular nerve 


Perforating branch of fibular artery 

Anterior lateral malleolar artery 




Lateral tarsal artery 



longus tendon 

Posterior perforating 

branches from 


deep plantar arch 

Anterior medial 

malleolar artery 



Medial tarsal artery 

Arcuate artery 

Deep plantar artery 

Dorsal metatarsal arteries 

Dorsal digital arteries 

Arteries and nerves of leg 


Arteries of leg (anterior view) 

346

Leg: cutaneous nerves 

6 

Anterior 

cutaneous nerves 


Branch of anterior 



Branches of posterior 



Cutaneous branch of 


Infrapatellar branch of 

saphenous nerve 

Terminal branches of 

posterior cutaneous 


Lateral sural 



Sural communicating 

branch of common 

fibular nerve 




Branches of saphenous nerve 

Sural nerve 


(medial dorsal cutaneous branch) 


(intermediate dorsal 

cutaneous branch) 

Lateral dorsal cutaneous nerve 

Lateral dorsal cutaneous nerve 

(from sural nerve) 

Medial plantar nerve 

Lateral plantar nerve 

Dorsal digital branch of deep 

fibular nerve 

Anterior view 


347

LOWER LIMB • Transverse sections: leg 


Bursa of tibial tuberosity 


Tibia 







Gracilis tendon 

Fibula 



Semitendinosus tendon 

Anserine bursa 

Popliteus 

A 

Soleus 



Tibial nerve 

Plantaris 








Fibula 


Soleus 

Fibular vessels 


Anterior tibial vessels 

Tibia 




Posterior tibial vessels 

Tibial nerve 


A 

B 

C 


B 

Sural nerve 






Tibia 

Fibula 




C Flexor hallucis longus 


Posterior tibial vessels 

Transverse sections through leg 

Tibial nerve 


348

Transverse sections: leg 

6 


Tibia 

Sartorius 



longus 


Fibula 

Soleus 

Gracilis 


Popliteus 




A 






Fibula 

Tibia 


Posterior tibial vessels and 

tibial nerve 



Soleus 


B 





Tibia 



Fibula 


Posterior tibial vessels and 

tibial nerve 




C 

Transverse/axial sections through the leg. 

A. Proximal/upper leg. T1-weighted MR image in axial plane 

B. Middle leg. T1-weighted MR image in axial plane 

C. Distal/lower leg. T1-weighted MR image in axial plane 

349

LOWER LIMB • Foot: muscle attachments 

Dorsal interossei 

Muscle attachments of the foot 


Flexor digitorum brevis 


Extensor 

hallucis 

longus 


longus and brevis 

Extensor 

hallucis 

brevis 

Abductor 

hallucis 

Plantar 

interossei 

1st 

2nd 

Dorsal 

interossei 3rd 

4th 


longus 

Flexor digiti 

minimi brevis 

Abductor digiti 

minimi 

Dorsal 

interossei 

1st 

2nd 

3rd 

4th 

Adductor hallucis 

(oblique head) 

3rd Plantar 

interosseus 


Abductor 

digiti minimi 


Flexor digiti 

minimi brevis 

Flexor hallucis brevis 

Extensor digitorum brevis 

Dorsal 

interossei 

Flexor 

hallucis 

brevis 

Abductor 

hallucis 

Adductor 

hallucis 

Plantar 

interossei 

1st Plantar 

interosseous 

2nd Plantar 

interosseous 




Quadratus plantae 

Abductor digiti minimi 


Abductor hallucis 


Origins 

Insertions 

Dorsal view 

Plantar view 

350

Foot: ligaments 

6 


metatarsal ligaments 

Fourth distal phalanx 

Fourth middle phalanx 

Fourth proximal phalanx 

Joint capsules 

of interphalangeal joints 

First distal phalanx 

Collateral ligaments 

Joint capsule 

of interphalangeal joint 

First proximal phalanx 

Joint capsule 

of metatarsophalangeal joint 

Plantar metatarsal ligaments 

Plantar ligaments 

Fifth 

metatarsal 

Plantar 

metatarsal 

ligaments 

Tuberosity 

of fifth 

metatarsal 



tendon 


Cuboid 

Plantar 

tarsometatarsal 

ligaments 

Plantar 

cuneonavicular 

ligament 

Navicular 

Plantar 

cuboideonavicular 

ligament 


tendon 

Tuberosity of 

cuboid 


tendon 

Long plantar 

ligament 

Calcaneus 

Plantar calcaneocuboid 

ligament 

(short plantar ligament) 


Plantar cuneonavicular 

ligament 


Plantar cuboideonavicular 

ligament 

Plantar calcaneonavicular 

ligament (spring ligament) 




Medial and lateral tubercles of talus 

Ligaments and tendons of 

the foot (plantar view) 

Deep plantar ligaments 

Plantar 

calcaneonavicular 

ligament 

(spring ligament) 


Talus 

Calcaneus 

Joint capsule 


Metatarsal bone 


Capsule and ligaments of the 

metatarsophalangeal and interphalangeal joint 

351

LOWER LIMB • Foot: ligaments 

Fibula 

Tibia 

Superior view 

talus removed 

Anterior 

talofibular 

ligament 


ligament 

Lateral 

talocalcaneal 

ligament 

Calcaneus 

Dorsal 

calcaneocuboid 

ligament 

Bifurcate 

ligament 

Tuberosity 

of fifth 

metatarsal 

Dorsal 

metatarsal 

ligaments 


metatarsal 

ligament 

Fifth proximal 

phalanx 

Fifth middle 

phalanx 

Talus 



Anterior tibiotalar part of 


Tibionavicular part of 


Navicular 


Dorsal cuneonavicular ligaments 

Dorsal intercuneiform ligaments 

Dorsal tarsometatarsal ligaments 

Joint capsule 

of metatarsophalangeal 

joint 

Lateral talocalcaneal 

ligament (cut) 

Calcaneal 

tendon (cut) 

Lateral view 

Cuboid 

Dorsal calcaneocuboid 

ligament 


Interosseous talocalcaneal 


Lateral talocalcaneal 


Calcaneus 

Interosseous talocalcaneal ligament 



Navicular 

Dorsal intercuneiform 

ligament Dorsal 

cuneocuboid 

ligament 

Fifth distal 

phalanx 


of interphalangeal joints 

First distal phalanx 

First proximal phalanx 

Anterior view 


Navicular 

Dorsal cuneonavicular ligaments 

Dorsal intercuneiform ligament 


Dorsal tarsometatarsal ligaments 



Calcaneus 

tendon (cut) 

Cuboid 


Dorsal calcaneocuboid ligament 

Fibularis brevis tendon (cut) 

Talus 


Flexor hallucis 

longus tendon (cut) 


of talus 

Calcaneal 

tendon (cut) 

Medial 

talocalcaneal 

ligament 

Calcaneus 

352 


Tibialis anterior tendon (cut) Long plantar ligament 

Plantar calcaneocuboid ligament (short plantar ligament) 

Medial view 


ligament 

Plantar aponeurosis (spring ligament) 

Tibialis posterior tendon (cut)


6 





Tibia 



Fibula 





longus tendon 


longus tendons 


longus tendon 


Synovial sheath of 

tibialis anterior 


extensor hallucis longus 


Synovial sheath 



Fibularis tertius tendon 


Extensor hallucis brevis 

(medial part of extensor digitorum brevis) 

Extensor digitorum longus tendons 


Fourth dorsal interosseous 

Third dorsal interosseous 

Second dorsal interosseous 

Extensor hallucis longus tendon 

First dorsal interosseous 

Dorsal hood 

Superficial structures of the foot (dorsal view) 

353

LOWER LIMB • Dorsum of foot: arteries and nerves 





Tibia 



longus 

Superficial fibular 

nerve 




nerve 

Fibula 

Anterior lateral 




longus tendon 




Lateral dorsal 


from sural nerve 







brevis 

Lateral tarsal branch 


Medial tarsal branch 

Medial branch of deep fibular nerve 






Innervation of the foot (dorsal view) 


Dorsal hood 


Dorsal digital branches of 

superficial fibular nerve 


Dorsal digital branches of 


Sural nerve 

Superficial 

fibular nerve 

354 

Arteries and nerves of the foot (dorsal view) 


Cutaneous distribution 

Deep 

fibular nerve 

Medial plantar 

nerve

Dorsum of foot: arteries and nerves 

6 

Tibia 


longus 





Fibula 




tendon 

















brevis (cut) 



Dorsal metatarsal 

arteries 






Posterior perforating branch 


Posterior perforating branches 

from deep plantar arch 

Deep plantar artery to 

deep plantar arch 

Deep plantar arch 

Branches of deep fibular 

nerve to first and second 

dorsal interossei 


Arteries of the foot (dorsal view) 



Dorsal metatarsal 

artery 

Dorsal digital 

arteries 


Deep arteries and nerves of the foot (dorsal view) 

Dorsal digital artery to next toe 

Metatarsal bone 

Dorsal metatarsal arteries 

Dorsal digital artery 

Proper plantar digital artery 

Proper plantar digital artery to next toe 

Plantar metatarsal arteries 

Anterior perforating branch 



Arteries of digit III (middle toe) 

355

LOWER LIMB • Plantar aponeurosis 


metatarsal ligaments 

Digital bands of 

plantar aponeurosis 

Transverse fasciculi 

Surface anatomy showing the area in contact 

with the ground when standing 

Anterior arm of inferior 

extensor retinaculum 


Plantar aponeurosis 


Lateral band of plantar aponeurosis 

(calcaneometatarsal ligament) 

Lateral process of calcaneal tuberosity 

Medial process of calcaneal tuberosity 


Superficial structures of the foot (plantar view) 

356

Plantar region (sole) musculature: first layer 

6 


Synovial sheaths 

Fibrous 

digital sheaths 

Fibrous digital sheath 


minimi 

Ligamentous 

attachment 

between 

calcaneus and 

metatarsal V 

First layer of muscles in 

the sole of the foot 

Abductor 

hallucis 

Flexor 

digitorum 

brevis 

Lumbricals 


longus tendon 


Flexor digitorum brevis tendons 

Flexor digiti minimi brevis 

Flexor digitorum 





Lateral process of calcaneal tuberosity 

Plantar aponeurosis (cut) 

Medial process of calcaneal tuberosity 


Muscles of sole of foot (first layer) 

357

LOWER LIMB • Plantar region (sole) musculature: second layer 

Flexor digitorum longus tendons 

Lumbricals 

Extensor hoods 

Quadratus 

plantae 


longus tendon 


Second layer of muscles in 



brevis tendons (cut) 

Lumbricals 




Abductor digiti minimi (cut) 

Abductor hallucis (cut) 







Flexor digitorum brevis (cut) 



Muscles of sole of foot (second layer) 

358

Plantar region (sole) musculature: third layer 

6 

Flexor digitorum longus tendons 

Transverse 

head 

Oblique 

head 

Adductor 

hallucis 

Flexor 

digiti minimi 

brevis 


brevis 



Tendons of 

lumbricals (cut) 

Sesamoid bones 


(transverse head) 

Third layer of muscles in 



minimi (cut) 

Flexor digitorum brevis tendons (cut) 

Plantar interossei 


(medial head) 















Quadratus plantae (cut) 


Flexor digitorum longus tendon (cut) 

Flexor hallucis longus tendon (cut) 






Muscles of sole of foot (third layer) 

359

LOWER LIMB • Plantar region (sole) musculature: fourth layer 

Deep transverse metatarsal 

ligaments 


Adduction 

Adduction 




transverse head 

(cut) 

Flexor hallucis brevis (cut) 


minimi (cut) 


oblique head (cut) 


3 

2 

1 

Flexor digiti 

minimi brevis 

(cut) 


Opponens 

digiti minimi 


oblique head (cut) 


brevis (cut) 

Abduction 


(unipennate) 

Abduction 


Flexor digiti minimi 

brevis (cut) 





Quadratus plantae (cut) 




4 

3 

2 

1 

Flexor digitorum longus tendon (cut) 


Flexor hallucis longus tendon (cut) 







(bipennate) 

Fourth layer of muscles in the sole of the foot 

Muscles of sole of foot (fourth layer) 

360

Plantar region (sole): arteries and nerves 

6 

Proper plantar digital branches 

of medial plantar nerve 




of lateral plantar nerve 

Saphenous 

nerve 

Proper plantar digital branch 

of superficial branch of 

medial plantar artery 

Sural nerve 

Tibial nerve 

Common plantar digital nerves 

Cutaneous distribution 

Proper plantar digital artery of fifth toe 




Superficial branch of lateral plantar nerve 

Deep branch of lateral plantar nerve 




Medial plantar artery 




Lateral plantar artery 


Lateral calcaneal artery 




Tibial nerve 




Medial calcaneal artery and nerve 

Arteries and nerves of sole of foot (plantar view) 

361

LOWER LIMB • Plantar region (sole): arteries and nerves 

Proper plantar digital arteries 

Proper plantar digital arteries 


of medial plantar nerve 

Proper plantar 

digital branches 

of lateral 

plantar nerve 



Posterior 

perforating branch 


lateral plantar nerve 


lateral plantar nerve 




Lateral plantar artery 


Lateral calcaneal artery 



Plantar metatarsal 

arteries 

First dorsal 

interosseous 

Posterior 

perforating 

branches 


Tibial nerve 

Deep plantar 

artery from 

dorsalis pedis 

artery 



longus tendon 






Medial calcaneal artery and nerve 

Arteries of sole of foot (plantar view) 

Plantar 

metatarsal 

arteries 

Deep plantar 

artery from 

dorsalis pedis 

artery 

Deep 

plantar arch 

Arcuate 

artery 

Medial 

plantar 

artery 

Lateral plantar 

artery 

Posterior 

tibial artery 

Arteries and nerves of sole of foot (plantar view) 

362

Dorsal hood and tarsal tunnel 

6 

Soleus 





Metatarsal II 



Extensor hood 

Fibularis 

longus 

Fibula 

Calcaneal 

tendon 



Lateral malleolus and 

subcutaneous bursa 




metatarsal ligament 


extensor hallucis longus 

Lumbrical 

Dorsal interosseous 

Extensor hood 

(posteromedial view) 


brevis tendon (cut) 



Extensor digitorum longus tendons 



Calcaneus Abductor digiti minimi 

Fibularis tertius tendon 



Lateral view 

Tibia 

Flexor retinaculum 

Calcaneus 



longus 

Posterior tibial Synovial sheath of tibialis 

artery and veins 

posterior tendon 


Tibial nerve 

Medial malleolar artery 


longus tendon 

Calcaneal 

tendon 


of extensor 


Synovial sheath of flexor 



and synovial sheath 

Medial malleolus and 

subcutaneous bursa 

Inferior extensor 

retinaculum 

Soleus 

Flexor 

digitorum 

longus 

Posterior tibial 

artery 

Tibial nerve 


of flexorhallucis 

longus 

Calcaneal 

tendon 

Medial 

calcaneal 

branches 

Tarsal tunnel and flexor retinaculum 

(posteromedial view) 

Metatarsal I 



Proper plantar digital branch 

of superficial branch of 

medial plantar artery 


longus tendon 


Medial view 

Medial tarsal artery 


Plantar aponeurosis 

Lateral plantar artery and nerve 

363

LOWER LIMB • Superficial veins of the lower limb 

Superficial circumflex 

iliac vein 

Superficial epigastric vein 

External pudendal veins 

Saphenous hiatus 

Fascia lata 

Accessory saphenous vein 

Anterior femoral 

cutaneous vein 


Branches of anterior 

femoral cutaneous vein 



Deep fascia of leg 


Dorsal venous arch of foot 

Anterior view 


364

Lymphatics of the lower limb 

6 

Superficial 


(superolateral nodes) 

Saphenous hiatus 

Superficial inguinal nodes 

(superomedial nodes) 

Superficial lymph vessels 

Superficial inguinal nodes 

(inferior nodes) 

Superficial lymph 

vessels from 

anterior surface 

Tibial nerve 

Superficial 

lymph vessels 


Popliteal nodes 






Plantar network of lymph vessels 

Dorsal network of 

lymph vessels 

Anterior view 


365

LOWER LIMB • Anterior cutaneous nerves and dermatomes of the lower limb 

Subcostal T12 



Ilio-inguinal L1 

Subcostal T12 






Medial and 

intermediate 

cutaneous of 

thigh L2,3 

Ilio-inguinal L1 




L1 

Infrapatellar branch 

of saphenous 

L2 

Lateral cutaneous of calf 

L5, S1,2 

Medial and intermediate 

cutaneous of thigh L2,3 


L3 



L5, S1,2 


L4 

Sural S1,2 

Deep fibular 


L5 

Cutaneous nerves of the lower limb 

Deep fibular 

Areas of distribution of the 

cutaneous nerves of the lower limb 

Sural S1,2 

S1 

L5 

L4 

366 

Dermatomes of the lower limb

Posterior cutaneous nerves and dermatomes of the lower limb 

6 

Posterior rami L1,2,3 

Subcostal T12 

Iliohypogastric L1 

Subcostal T12 

Iliohypogastric L1 

Posterior rami L1,2,3 

Posterior rami S1,2,3 

Posterior rami S1,2,3 



S4 

S3 

L2 





of thigh S1,2,3 


Medial cutaneous of thigh 

L2,3 

L3 

S2 

Medial cutaneous of thigh 

L2,3 





L5, S1,2 


of common fibular 

L4 


L5, S1,2 



L5 


Tibial 



S1 

Tibial 



Cutaneous nerves of the lower limb 

L4 

L5 




cutaneous nerves of the lower limb 

Dermatomes of the lower limb 

367

LOWER LIMB • Tables 

Branches of the lumbosacral plexus associated with the lower limb 

Branch 


Function: motor 

Function: sensory (cutaneous) 

Ilio-inguinal 

1 

L1 

No motor function in lower limb, but 

innervates muscles of the abdominal wall 

Skin over anteromedial part of upper 

thigh and adjacent skin of perineum 

Genitofemoral 

2 

L1, L2 

No motor function in lower limb, but 

genital branch innervates cremaster 

muscle in the wall of the spermatic cord 

in men 

Femoral branch innervates skin on 

anterior central part of upper thigh; the 

genital branch innervates skin in anterior 

part of perineum (anterior scrotum in 

men, and mons pubis and anterior labia 

majora in women) 

Femoral 

3 

L2 to L4 

All muscles in the anterior compartment 

of thigh; in the abdomen, also gives rise 

to branches that supply iliacus and 

pectineus 

Skin over the anterior thigh, 

anteromedial knee, medial side of the 

leg, and the medial side of the foot 

Obturator 

4 

L2 to L4 

All muscles in the medial compartment of 

thigh (except pectineus and the part of 

adductor magnus attached to the 

ischium); also innervates obturator 

externus 

Skin over upper medial aspect of thigh 

Sciatic 

5 

L4 to S3 

All muscles in the posterior compartment 

of thigh and the part of adductor magnus 

attached to the ischium; all muscles in the 

leg and foot 

Skin over lateral side of leg and foot, and 

over the sole and dorsal surface of foot 


6 

L4 to S1 

Muscles of the gluteal region (gluteus 

medius, gluteus minimus, tensor fasciae 

latae) 


7 

L5 to S2 

Muscle of the gluteal region (gluteus 

maximus) 



8 

L2, L3 

Parietal peritoneum in iliac fossa; skin 

over anterolateral thigh 



9 

S1 to S3 

Skin over gluteal fold and upper medial 

aspect of thigh and adjacent perineum, 

posterior aspect of thigh, and upper 

posterior leg 

Nerve to quadratus 

femoris 

10 

L4 to S1 

Muscles of gluteal region (quadratus 

femoris and gemellus inferior) 


internus 

11 

L5 to S2 

Muscles of gluteal region (obturator 

internus and gemellus superior) 

Perforating 


12 

S2, S3 

Skin over medial aspect of gluteal fold 

368

Tables 

6 

1 

2 

8 

3 

4 

6 

7 

9 12 

11 

5 

10 

369


Muscles of the gluteal region 


Muscle 

Origin 

Insertion 

Innervation 

Function 

Piriformis 

1 

Anterior surface of sacrum 

between anterior sacral 

foramina 

Medial side of superior border of 

greater trochanter of femur 

Branches from 

L5, S1, S2 

Laterally rotates the extended 

femur at hip joint; abducts 

flexed femur at hip joint 

Obturator 

internus 

2 

Anterolateral wall of true 

pelvis; deep surface of 

obturator membrane and 

surrounding bone 

Medial side of greater trochanter 



internus (L5, S1) 




Gemellus 

superior 

3 

External surface of ischial 

spine 

Along length of superior surface 

of the obturator internus tendon 

and into the medial side of 

greater trochanter of femur with 

obturator internus tendon 


internus (L5, S1) 




Gemellus 

inferior 

4 

Upper aspect of ischial 

tuberosity 

Along length of inferior surface of 

the obturator internus tendon and 

into the medial side of greater 

trochanter of femur with obturator 

internus tendon 

Nerve to 

quadratus femoris 

(L5, S1) 




Quadratus 

femoris 

5 

Lateral aspect of the ischium 

just anterior to the ischial 

tuberosity 

Quadrate tubercle on the 

intertrochanteric crest of the 

proximal femur 

Nerve to 

quadratus femoris 

(L5, S1) 

Laterally rotates femur at hip 

joint 

Gluteus 

minimus 

6 

External surface of ilium 

between inferior and anterior 

gluteal lines 

Linear facet on the anterolateral 

aspect of the greater trochanter 


nerve (L4, L5, S1) 

Abducts femur at hip joint; 

holds pelvis secure over 

stance leg and prevents 

pelvic drop on the opposite 

swing side during walking; 

medially rotates thigh 

Gluteus 

medius 

7 

External surface of ilium 

between anterior and 

posterior gluteal lines 

Elongate facet on the lateral 

surface of the greater trochanter 



Abducts femur at hip joint; 

holds pelvis secure over 

stance leg and prevents 

pelvic drop on the opposite 

swing side during walking; 

medially rotates thigh 

Gluteus 

maximus 

8 

Fascia covering gluteus 

medius, external surface of 

ilium behind posterior gluteal 

line, fascia of erector spinae, 

dorsal surface of lower 

sacrum, lateral margin of 

coccyx, external surface of 

sacrotuberous ligament 

Posterior aspect of iliotibial tract 

of fascia lata and gluteal 

tuberosity of proximal femur 


nerve (L5, S1, S2) 

Powerful extensor of flexed 

femur at hip joint; lateral 

stabilizer of hip joint and knee 

joint; laterally rotates and 

abducts thigh 

Tensor 

fasciae latae 

9 

Lateral aspect of crest of ilium 

between anterior superior iliac 

spine and tubercle of the crest 

Iliotibial tract of fascia lata 



Stabilizes the knee in 

extension 

370

Tables 

6 

1 

5 

6 

3 

4 

9 

2 

7 

8 

371


Muscles of the anterior compartment of thigh 


Muscle 

Origin 

Insertion 

Innervation 

Function 

Psoas major 

1 

Posterior abdominal wall 

(lumbar transverse 

processes, intervertebral 

discs, and adjacent bodies 

from TXII to LV and tendinous 

arches between these points) 


Anterior rami 

[L1, L2, L3] 

Flexes the thigh at the hip 

joint 

Iliacus 

2 

Posterior abdominal wall 

(iliac fossa) 


Femoral nerve 

[L2, L3] 


joint 


3 

Femur—medial part of 

intertrochanteric line, 

pectineal line, medial lip of the 

linea aspera, medial 

supracondylar line 


and medial border of patella 

Femoral nerve 

[L2, L3, L4] 

Extends the leg at the knee 

joint 

Vastus 

intermedius 

4 

Femur—upper two thirds of 

anterior and lateral surfaces 


and lateral margin of patella 

Femoral nerve 

[L2, L3, L4] 


joint 


5 

Femur—lateral part of 

intertrochanteric line, margin 

of greater trochanter, lateral 

margin of gluteal tuberosity, 

lateral lip of the linea aspera 


Femoral nerve 

[L2, L3, L4] 


joint 


6 

Straight head originates from 

the anterior inferior iliac spine; 

reflected head originates from 

the ilium just superior to the 

acetabulum 


Femoral nerve 

[L2, L3, L4] 


joint and extends the leg at 

the knee joint 

Sartorius 

7 


Medial surface of tibia just 

inferomedial to tibial 

tuberosity 

Femoral nerve 

[L2, L3] 


joint and flexes the leg at the 

knee joint 

372

Tables 

6 

1 

2 

3 

4 

7 

5 

6 

373


Muscles of the medial compartment of thigh 


Muscle 

Origin 

Insertion 

Innervation 

Function 

Gracilis 

1 

A line on the external surfaces 

of the body of the pubis, the 

inferior pubic ramus, and the 

ramus of the ischium 

Medial surface of proximal 

shaft of tibia 


[L2, L3] 

Adducts thigh at hip joint and 

flexes leg at knee joint 

Pectineus 

2 

Pectineal line (pecten pubis) 

and adjacent bone of pelvis 

Oblique line extending from 

base of lesser trochanter to 

linea aspera on posterior 

surface of proximal femur 

Femoral nerve 

[L2, L3] 

Adducts and flexes thigh at 

hip joint 


3 

External surface of body of 

pubis (triangular depression 

inferior to pubic crest and 

lateral to pubic symphysis) 

Linea aspera on middle 

one third of shaft of femur 


(anterior division) 

[L2, L3, L4] 

Adducts and medially rotates 

thigh at hip joint 


4 

External surface of body of 

pubis and inferior pubic ramus 

Posterior surface of proximal 

femur and upper one third of 

linea aspera 


[L2, L3] 



Adductor 

magnus 

5 

Adductor part—ischiopubic 

ramus 

Hamstring part—ischial 

tuberosity 

Posterior surface of proximal 

femur, linea aspera, medial 


Adductor tubercle and 



[L2, L3, L4] 

Sciatic nerve 

(tibial division) 

[L2, L3, L4] 



Obturator 

externus 

6 

External surface of obturator 

membrane and adjacent bone 



(posterior division) 

[L3, L4] 

Laterally rotates thigh at hip 

joint 

2 

6 

4 

5 

1 

3 

374

Tables 

6 

Muscles of the posterior compartment of thigh 


Muscle 

Origin 

Insertion 

Innervation 

Function 


1 

Long head—inferomedial part 

of the upper area of the 

ischial tuberosity; short 

head—lateral lip of linea 

aspera 


Sciatic nerve 

[L5, S1, S2] 

Flexes leg at knee joint; extends 

and laterally rotates thigh at hip 

joint and laterally rotates leg at 

knee joint 


2 

Inferomedial part of the upper 

area of the ischial tuberosity 

Medial surface of 

proximal tibia 

Sciatic nerve 

[L5, S1, S2] 

Flexes leg at knee joint and 

extends thigh at hip joint; medially 

rotates thigh at hip joint and leg at 

knee joint 


3 

Superolateral impression on 

the ischial tuberosity 

Groove and adjacent 

bone on medial and 

posterior surface of 

medial tibial condyle 

Sciatic nerve 

[L5, S1, S2] 

Flexes leg at knee joint and 

extends thigh at hip joint; medially 

rotates thigh at hip joint and leg at 

knee joint 

1 

2 

3 

375


Superficial group of muscles in the posterior compartment of leg 


Muscle 

Origin 

Insertion 

Innervation 

Function 

Gastrocnemius 

1 

Medial head—posterior surface of distal 

femur just superior to medial condyle; 

lateral head—upper posterolateral 

surface of lateral femoral condyle 

Via calcaneal tendon, 

to posterior surface 

of calcaneus 

Tibial nerve 

[S1, S2] 

Plantarflexes foot and flexes 

knee 

Plantaris 

2 

Inferior part of lateral supracondylar line 

of femur and oblique popliteal ligament 

of knee 




Tibial nerve 

[S1, S2] 

Plantarflexes foot and flexes 

knee 

Soleus 

3 

Soleal line and medial border of tibia; 

posterior aspect of fibular head and 

adjacent surfaces of neck and proximal 

shaft; tendinous arch between tibial and 

fibular attachments 




Tibial nerve 

[S1, S2] 

Plantarflexes the foot 

2 

1 

3 

376

Tables 

6 

Deep group of muscles in the posterior compartment of leg 


Muscle 

Origin 

Insertion 

Innervation 

Function 

Popliteus 

1 


Posterior surface of 

proximal tibia 

Tibial nerve 

[L4 to S1] 

Stabilizes knee joint (resists 

lateral rotation of tibia on femur) 

Unlocks knee joint (laterally 

rotates femur on fixed tibia) 


longus 

2 

Posterior surface of fibula and 

adjacent interosseous 

membrane 

Plantar surface of distal 

phalanx of great toe 

Tibial nerve 

[S2, S3] 

Flexes great toe 


longus 

3 

Medial side of posterior 

surface of the tibia 

Plantar surfaces of bases 

of distal phalanges of the 

lateral four toes 

Tibial nerve 

[S2, S3] 

Flexes lateral four toes 


4 

Posterior surfaces of 

interosseous membrane and 

adjacent regions of tibia and 

fibula 

Mainly to tuberosity of 

navicular and adjacent 

region of medial cuneiform 

Tibial nerve 

[L4, L5] 

Inversion and plantarflexion of 

foot; support of medial arch of 

foot during walking 

1 

2 3 4 

377


Muscles of the lateral compartment of leg 


Muscle 

Origin 

Insertion 

Innervation 

Function 


1 

Upper lateral surface of 

fibula, head of fibula, and 

occasionally the lateral tibial 

condyle 

Undersurface of lateral sides 

of distal end of medial 

cuneiform and base of 

metatarsal I 


nerve [L5, S1, S2] 

Eversion and plantarflexion 

of foot; supports arches of 

foot 


2 

Lower two thirds of lateral 

surface of shaft of fibula 

Lateral tubercle at base of 

metatarsal V 


nerve [L5, S1, S2] 

Eversion of foot 

Muscles of the anterior compartment of leg 


3 

Lateral surface of tibia and 

adjacent interosseous 

membrane 

Medial and inferior surfaces of 

medial cuneiform and 

adjacent surfaces on base of 

metatarsal I 


[L4, L5] 

Dorsiflexion of foot at ankle 

joint; inversion of foot; 

dynamic support of medial 

arch of foot 

Extensor 


4 

Middle one half of medial 

surface of fibula and adjacent 

surface of interosseous 

membrane 

Dorsal surface of base of 

distal phalanx of great toe 


[L5, S1] 

Extension of great toe and 

dorsiflexion of foot 

Extensor 


5 

Proximal one half of medial 

surface of fibula and related 

surface of lateral tibial 

condyle 

Via dorsal digital expansions 

into bases of distal and 

middle phalanges of lateral 

four toes 


[L5, S1] 

Extension of lateral four toes 

and dorsiflexion of foot 


6 

Distal part of medial surface 


Dorsomedial surface of base 

of metatarsal V 


[L5, S1] 

Dorsiflexion and eversion of 

foot 

Muscles of the dorsal aspect of the foot 

Extensor 

digitorum brevis 

7 

Superolateral surface of the 

calcaneus 

Lateral sides of the tendons of 

extensor digitorum longus of 

toes II to IV 


[S1, S2] 

Extension of 

metatarsophalangeal joints 

of toes II to IV 

Extensor 

hallucis brevis 

8 

Superolateral surface of 

calcaneus 

Base of proximal phalanx of 

great toe 


[S1, S2] 


metatarsophalangeal joint 

of great toe 

378

Tables 

6 

3 

4 5 

1 

2 

6 

7 8 

379


First layer of muscles in the sole of the foot 


Muscle 

Origin 

Insertion 

Innervation 

Function 

Abductor 

hallucis 

1 

Medial process of 

calcaneal tuberosity 

Medial side of base of 

proximal phalanx of 

great toe 

Medial plantar nerve from 

the tibial nerve 

[S1, S2, S3] 

Abducts and flexes great toe at 



brevis 

2 

Medial process of 

calcaneal tuberosity and 

plantar aponeurosis 

Sides of plantar surface 

of middle phalanges of 

lateral four toes 

Medial plantar nerve from 


[S1, S2, S3] 

Flexes lateral four toes at 

proximal interphalangeal joint 


minimi 

3 

Lateral and medial 

processes of calcaneal 

tuberosity, and band of 

connective tissue 

connecting calcaneus 

with base of metatarsal V 

Lateral side of base of 

proximal phalanx of little 

toe 

Lateral plantar nerve from 


[S1, S2, S3] 

Abducts little toe at the 


Second layer of muscles in the sole of the foot 

Quadratus 

plantae 

4 

Medial surface of 

calcaneus and lateral 

process of calcaneal 

tuberosity 

Lateral side of tendon of 

flexor digitorum longus 

in proximal sole of the 

foot 

Lateral plantar nerve from 

tibial nerve [S1, S2, S3] 

Assists flexor digitorum longus 

tendon in flexing toes II to V 

Lumbricals 

5 

First lumbrical—medial 

side of tendon of flexor 


associated with toe II; 

second, third, and fourth 

lumbricals—adjacent 

surfaces of adjacent 

tendons of flexor 


Medial free margins of 

extensor hoods of toes 

II to V 

First lumbrical—medial 

plantar nerve from the tibial 

nerve; second, third, and 

fourth lumbricals—lateral 

plantar nerve from the tibial 

nerve [S2, S3] 

Flexion of metatarsophalangeal 

joint and extension of 

interphalangeal joints 

5 

3 

1 

2 

4 

380

Tables 

6 

Third layer of muscles in the sole of the foot 


Muscle 

Origin 

Insertion 

Innervation 

Function 

Flexor digiti 

minimi brevis 

1 

Base of metatarsal V and 

related sheath of fibularis 

longus tendon 


proximal phalanx of little 

toe 


from tibial nerve [S2, S3] 

Flexes little toe at 



brevis 

2 

Plantar surface of cuboid and 

lateral cuneiform; tendon of 

tibialis posterior 

Lateral and medial sides 

of base of proximal 

phalanx of the great toe 


from tibial nerve 

[S1, S2] 

Flexes metatarsophalangeal 

joint of the great toe 

Adductor 

hallucis 

3 

Transverse head—ligaments 

associated with 

metatarsophalangeal joints of 

lateral three toes; oblique 

head—bases of metatarsals II 

to IV and from sheath 

covering fibularis longus 


proximal phalanx of great 

toe 


from tibial nerve 

[S2, S3] 

Adducts great toe at 


Fourth layer of muscles in the sole of the foot 

Dorsal 

interossei 

4 

Sides of adjacent metatarsals 

Extensor hoods and bases 

of proximal phalanges of 

toes II to IV 


from tibial nerve; first 

and second dorsal 

interossei also 

innervated by deep 

fibular nerve [S2, S3] 

Abduction of toes II to IV at 

metatarsophalangeal joints; 

resist extension of 


and flexion of 


Plantar 

interossei 

5 

Medial sides of metatarsals 

of toes III to V 

Extensor hoods and bases 


toes III to V 


from tibial nerve [S2, S3] 

Adduction of toes III to V at 

metatarsophalangeal joints; 

resist extension of the 


and flexion of the 


1 

3 

2 4 

5 

381


7 

CONTENTS 

UPPER LIMB 



Bony framework of shoulder 386 

Scapula 387 

Clavicle: joints and ligaments 388 








Deep vessels and nerves of the shoulder 400 


Brachial artery 402 


Medial and lateral cords 404 


Distal end of humerus and proximal end of 

radius and ulna 406 



Anterior compartment: arteries and nerves 410 



Posterior compartment: arteries and nerves 414 



Anterior cutaneous nerves of the arm 418 


Elbow joint 420 


Cubital fossa 424 


Bones of the hand and wrist joint 426 


Bones of the hand 428 


Muscle attachments of forearm 430 


Anterior compartment of forearm: 



Posterior compartment of forearm: 




Muscle attachments of the hand 442 


Tendon sheaths of hand 444 




Arteries of the hand 450 


Dorsum of hand 452 

Dorsal hoods 453 

Dorsum of hand: arteries 454 


Anatomical snuffbox 456 


Anterior cutaneous nerves of forearm 458 


Tables 460

UPPER LIMB • Surface anatomy 

Clavicle 

Trapezius 

Trapezius 

Acromion 

Acromion 

Deltoid 

Deltoid 

Cephalic vein 




(long head) 

Cubital fossa 





tendon 

Olecranon 


(and brevis) 



Anterior view 


Thenar 

eminence 

Basilic vein 

Palmaris longus tendon 

Hypothenar eminence 

Palm 

Extensor digitorum tendons 

Metacarpophalangeal (MP) joint 

Proximal interphalangeal (PIP) joint 

Distal interphalangeal (DIP) joint 

Little finger (digit V) 

Ring finger (digit IV) 

Middle finger (digit III) 

Index finger (digit II) 

Thumb (digit I) 

Extensor pollicis longus tendon 

384




Clavicle 


Acromion 

Shoulder 

Glenohumeral joint 

Acromion 

Spine of 

scapula 

Arm 

Humerus 

Scapula 

Humerus 

Elbow joint 

Olecranon 

Forearm 

Anterior view 


Radius 

Ulna 

Ulna 

Radius 

Wrist joint 

Carpals 

Metacarpals 

Hand 

Phalanges 

385

UPPER LIMB • Bony framework of shoulder 

Cervical vertebrae CI-VII 

Superior transverse scapular ligament 

Acromion 

Rib I 

Clavicle 



Sternoclavicular 

joint 

Acromion 

Supraspinous 

fossa 


Rib I 

Clavicle 


Humerus 


Suprascapular 

notch 

Manubrium 


Infraspinous 

fossa 

Sternal 

angle 

Anterior view 

Humerus 

Supraspinous fossa 

Scapula 

Transverse process of TI 

Rib I 


Lateral view 

Acromion 

Head of humerus 


Intertubercular sulcus 


Humerus 

Bony framework of shoulder 


Coracoid 

process 


386 

Clavicle 

Superior view 

Sternum

Scapula 7 

Supraspinous 

fossa 

Superior angle 


Superior border 

Suprascapular 

notch 

Articular surface for clavicle 

Acromion 

Greater scapular notch (or spinoglenoid notch) 

Glenoid cavity 


Infraglenoid tubercle 

Acromion 

Superior border 

Suprascapular notch 




Infraspinous fossa 


Medial border 

Scapula posterior view 

Acromion 




Supraglenoid tubercle 

Subscapular fossa 




Medial 

border 




Scapula anterior view 

Scapula lateral view 


387

UPPER LIMB • Clavicle: joints and ligaments 

Trapezius 


Clavicle (superior view) 

Deltoid 


Muscle attachments (superior view) 

Surface for articulation 

with acromion 

Lateral 

Medial 

Surface for articulation with 

manubrium of sternum 

and first costal cartilage 

Origins 

Insertions 

Trapezoid line Conoid tubercle 

(for trapezoid and conoid parts of 

coracoclavicular ligament) 

Subclavian groove 

(for attachment of 

subclavius muscle) 

Clavicle (inferior view) 

Impression for 

costoclavicular ligament 

Deltoid 

Subclavius 


Trapezius 

Muscle attachments (inferior view) 

Coracoclavicular ligament 

Acromioclavicular 

ligament 


Acromion 

Trapezoid ligament 

Conoid ligament 

Articular disc 

(capsule and ligaments 

removed anteriorly to 

expose joint) 

Clavicular notch 


Interclavicular ligament 

Anterior sternoclavicular ligament 

Clavicle 

Coraco-acromial 

ligament 


Rib I 


Costoclavicular ligament 

First costal cartilage 

Attachment site for costal 

cartilage of rib II 


Sternal angle 

Joints and ligaments of the clavicle (anterior view) 

388


Superior facet on greater tubercle 

(for attachment of supraspinatus) 


Intertubercular 

sulcus 



(for attachment of subscapularis) 

Anatomical neck 



Surgical neck 

Lateral lip of intertubercular sulcus 

(for attachment of pectoralis major) 

Medial lip of intertubercular sulcus 

(for attachment of teres major) 

Roughening in floor of sulcus 

(for attachment of latissimus dorsi) 


Surgical neck 




Anterior view 

Medial view 




Superior facet 

(for attachment 

of supraspinatus) 


Humeral head (superior view) 



Surgical neck 

Surgical neck 

Middle facet 


of infraspinatus) 

Inferior facet 


of teres minor) 

Radial groove of humerus 

Roughening 

(for attachment of 

coracobrachialis) 

Deltoid tuberosity 


of deltoid) 

Lateral view 


Proximal end of humerus 

389

UPPER LIMB • Glenohumeral joint 

Acromion 

Scapula 







Acromion 


ligament 


Transverse 

humeral 

ligament 

Redundant synovial 

membrane in adduction 

Tendon of long head 

of biceps brachii 

Glenoid labrum 




Tendon of short head of 

biceps brachii 

Humerus 

Origins of biceps brachii tendons (superior view) 

Articular surfaces of glenohumeral joint (anterolateral oblique view) 


Scapula 

Coracohumeral ligament 

Superior glenohumeral ligament 

Acromion 


Aperture for subtendinous 

bursa of subscapularis 

Acromion 



Middle glenohumeral ligament 

Tendon of long head of 


Tendon of short head of 




Tendon of long head of biceps brachii 

Inferior 

glenohumeral 

ligament 

Redundant capsule 

Humerus 

Synovial membrane (superior view) 

Fibrous membrane of joint capsule (anterior view) 

390


Acromion 

Supraspinatus 





Deltoid 

Humerus 

Anterior view of the glenohumeral joint. 


Clavicle 

Acromion 



Humerus 

Normal glenohumeral joint. 


391

UPPER LIMB • Muscle attachments 


Acromion 




infraspinatus (cut) 

Subacromial bursa 

(subdeltoid) 


Supraspinatus (cut) 




Transverse humeral 

ligament 




of biceps brachii (cut) 

Humerus 

Subtendinous bursa of subscapularis (cut) 

Tendon of short head of biceps brachii (cut) 

Tendon of subscapularis (cut) 

Bursae of the glenohumeral joint (superior view) 


Acromion 


Glenoid labrum Supraspinatus 

Scapula 

Tendon of supraspinatus 

Subacromial bursa 

(subdeltoid) 


Axillary recess 

Deltoid 

Humerus 


Teres minor 

Teres major (cut) 

392 

Glenohumeral joint (anterior view)


Pectoralis major (clavicular part) 

Origins 

Insertions 

Subclavius 

Pectoralis major (sternocostal part) 


Rib cage attachments of the 

pectoral muscles (anterior view) 

Posterior scalene 

Middle scalene 

Anterior scalene 

Serratus anterior (Ribs I–IX) 

Trapezius 

(Superior nuchal line, 

external occipital 

protuberance, 

ligamentum nuchae, 

supraspinous ligament 

and spinous process 

CVII–TXII) 

Latissimus dorsi muscle 

(Spinous process TVII–TXII, 

supraspinous ligament and 

spinous process LI–SV, sacrum, 

iliac crest, ribs X–XII) 

Rib cage attachments of serratus anterior 

and scalene muscles (lateral view) 

Attachments of trapezius and 

latissimus dorsi muscles (lateral view) 

393

UPPER LIMB • Pectoral region 

Sternum 



Scapula 


Pectoralis major and minor muscles on anterior thoracic wall. 



Acromion 

Trapezius 


Cephalic vein 


jugular vein 

Clavicle 

Clavicular part of 


Deltoid 

Sternum 


Sternocostal part of 


Brachial vein 


Lateral head of triceps brachii 

Humerus 

Costal margin 

Lateral intermuscular septum 




(from aponeurosis of 

external oblique) 

Medial intermuscular septum 


394


Brachial plexus Middle trunk 

Inferior trunk 



Clavicular branch of thoraco-acromial artery Trapezius 

Acromion 

Acromial branch of thoraco-acromial artery 

Deltoid 


Superior trunk 

Right common 



jugular vein 

Lateral pectoral nerve 

Deltoid branch of 



Medial pectoral nerve 

Cephalic vein 

Long head of biceps brachii 

Short head of biceps brachii 

Attachment of clavipectoral 

fascia to floor of axilla 

Brachial vein 


Pectoral branch of 



surrounded by the 

clavipectoral fascia 


Supraspinatus 

Clavipectoral fascia and related structures 

Clavicle 


Acromion 

Subclavius 

Subscapularis 







Radial nerve 

Median nerve 


Brachial vein 


Humerus 

Ulnar nerve 


Long thoracic nerve 


395

UPPER LIMB • Walls of the axilla 


Acromion 

Clavicle 



Sternum 

Pectoralis major (cut) 

External intercostals 

Trapezius 

Clavicle 

Supraspinatus 

Acromion 


Scapula 


ligament 


Subscapularis 


Pectoralis major (cut) 



Teres major 

Medial and anterior walls of axilla 

Inlet 

• lateral margin of rib I 

• clavicle 

• superior margin of 

scapula to coracoid process 


Humerus 

Anterior wall 

• pectoralis major and minor 

• subclavius 

• clavipectoral fascia 

Lateral wall 

• intertubercular 

sulcus 

Medial wall 

• upper thoracic wall 

• serratus anterior 


triceps brachii 



Floor 

• skin of armpit 

• open laterally into arm 

Posterior and lateral walls of axilla 

Posterior wall 

• subscapularis, teres major 

and latissimus dorsi, and 

long head of triceps brachii 

Boundaries of axilla 

396


Supraspinatus 

Axillary inlet 


Acromioclavicular ligament 

Acromion 

Clavipectoral (deltopectoral) triangle 

Deltoid 

Rib I 

Clavicle 

Manubrium 


Subclavius 

Clavicle 

Humerus 



Axillary inlet (superior view) 






Teres major 

Humerus 


Humerus 

Anterior wall of axilla (posterior view) 

Lateral wall of axilla (medial view) 

397

UPPER LIMB • The four rotator cuff muscles 

1 

2 

3 

4 

Supraspinatus 

Infraspinatus 

Teres minor 

Subscapularis 

1 


Supraspinatus 


Acromioclavicular ligament 

Acromion 

2 

Infraspinatus 

Rib I 

1 

Supraspinatus 

Clavicle 

Coraco-acromial ligament 

4 

Subscapularis 



1 Supraspinatus 

Clavicle 

Acromion 


Sternum 

Muscles of the scapula (superior view) 

2 Infraspinatus 

Coraco-acromial ligament 


3 Teres minor 




Acromion 

Teres major 

Deltoid 

2 

Infraspinatus 

Serratus 

anterior 



3 Teres minor 

Humerus 

Teres major 

4 

Subscapularis 

Long head 

of triceps brachii 


398 

Muscles of the scapula (posterior view) 

Muscles associated 

with the glenohumeral joint 

(lateral view)


1 

Supraspinatus 

Clavicle 


in intertubercular sulcus 



Head of 

humerus 

Deltoid 

Cephalic vein 

Rib I 

Sternum 



Tendon of short head 


2 

Infraspinatus 

4 

Subscapularis 

4 

Subscapularis 

3 

Teres minor 

Humerus 


Infraspinatus 

2 


Muscles associated with the glenohumeral joint. 



Acromion 

1 

Supraspinatus 

Clavicle 


ligament 


Muscles of the scapula (lateral view) 

2 Infraspinatus 


Acromion Clavicle 

Quadrangular space 

4 Subscapularis 

Triangular space 

Triangular interval 





Teres major 


4 

Subscapularis 

Humerus 




3 Teres minor 


Muscles associated with the glenohumeral joint. 


Muscles of the scapula and gateways to 

the posterior scapular region (anterior view) 

399

UPPER LIMB • Deep vessels and nerves of the shoulder 





(dorsal scapular artery) 

Rib I 

Suprascapular artery 


Clavicle 

Acromion 



Scapula 


Humerus 


cervical artery 




Circumflex scapular artery 

(from subscapular artery) 

Arteries of the shoulder (posterior view) 








Suprascapular artery and nerve 


Acromion 

Tendon of supraspinatus 

Deltoid 

Suprascapular artery and nerve 

Tendon of infraspinatus 


Supraspinatus 

Infraspinatus 




nerve of arm 


Teres minor 

Teres major 

Radial nerve 







400 

Deep arteries and nerves of the shoulder (posterior view)



First part 

Lateral margin of rib I 

Second part 

Third part 

Superior thoracic artery 

Anterior circumflex 

humeral artery 

Posterior circumflex 

humeral artery 



Subscapular artery 

Thoracodorsal artery 




Lower border of teres major 


Axillary artery (anterior view) 




Acromion 

Supraspinatus 






Transverse humeral ligament 

Subscapularis 





Teres major 




Humeral nutrient artery 

Related image 


Humerus 

Radial collateral artery 



Inferior ulnar 

collateral artery 

Brachial artery and its origin 

401

UPPER LIMB • Brachial artery 

Acromial branch of 







Deltoid branch of 






Thoracodorsal artery 


Humerus 

Superior ulnar collateral artery 


Clavicular branch of thoraco-acromial artery 

Pectoral branch of thoraco-acromial artery 

Deep branch of transverse cervical artery 



Scapula 


Middle scalene muscle 


Transverse cervical artery 

Arteries of the shoulder (anterior view) 

Clavicular branch of 


Acromial branch of 




Subclavius 














Superior ulnar 


402 



Branches of the axillary artery 



Terminal 

nerves 

Cords Divisions Trunks Roots 

(anterior rami) 

Musculocutaneous 


Suprascapular nerve 


C5 

Median 

Radial 

Axillary 

Lateral 

Posterior 

Anterior 

Anterior 

Posterior Posterior 

Superior 


Middle 

Contribution 

to phrenic 

nerve 

C6 

C7 

Ulnar 

Superior 

subscapular nerve 

Thoracodorsal nerve 

Inferior subscapular nerve 

Medial 

Posterior 

Anterior 

Inferior 

C8 

Superior cervical sympathetic ganglion 


Medial cutaneous nerve of arm 

T1 

Medial cutaneous nerve of forearm 


Schematic showing branches of the brachial plexus 

Gray rami 

communicantes 

Middle cervical sympathetic ganglion 

Medial cord 

Posterior cord 

Lateral cord 




Inferior cervical sympathetic ganglion 

Phrenic nerve 



Suprascapular nerve 

C5 

C6 

C7 

C8 

T1 




Intercostobrachial nerve 


Radial nerve 


Median nerve 

Ulnar nerve 


403 


UPPER LIMB • Medial and lateral cords 


Lateral cord 

Medial cord 



Cords around the axillary artery 



Middle trunk 

Inferior trunk 


Medial cord 


Lateral cord 









Median nerve 



Ulnar nerve 


Brachialis 


nerve of forearm 

(from musculocutaneous nerve) 

Lateral and medial cords of the brachial plexus 

404 



Trapezius 

Supraspinatus 

Clavicle 


Medial cord 

Lateral cord 

Subscapularis 





Radial nerve 

Teres major 


Superior 

subscapular nerve 







Humerus 

Radial nerve 

Ulnar nerve 

Median nerve 



Posterior cord of the brachial plexus 

(ribs and associated muscles removed) 

405 


UPPER LIMB • Distal end of humerus and proximal end of radius and ulna 

Lateral view Anterior view Posterior view Medial view 


Medial border 

Lateral 

supracondylar ridge 

Radial fossa 

Coronoid fossa 

Medial 


Medial 


Olecranon fossa 


Capitulum Trochlea 


Condyles 

Distal end of humerus 

Trochlea 



Roughening for triceps attachment 

Olecranon 

Radial notch 

Supinator 

crest 

Trochlear 

notch 

Coronoid 

process 

Olecranon 

Subcutaneous 

surface 

Tuberosity of ulna 

Coronoid 

process 

Radial notch 

Roughening 

for anconeus 

Supinator crest 

Lateral view Anterior view Posterior view Medial view 

Proximal end of ulna 

Articular facet for capitulum 

Head 

Neck 

Head 

Neck 

Radial tuberosity 

Oblique line 

406 

Anterior view 


Proximal end of radius 



Deltoid 

Omohyoid 

Trapezius 

Biceps brachii (short head) 

and coracobrachialis 

Supraspinatus 


Biceps brachii (long head) 

Subscapularis 


Subscapularis 


Teres major 


Deltoid 


muscle (long head) 


Muscle attachments of the shoulder and arm 


Supraspinatus 

Trapezius 

Deltoid 

Brachialis 

Supraspinatus 



Infraspinatus 

Teres minor 


Extensor carpi 

radialis longus 

Common 

extensor tendon 


(humeral head) 



(long head) 




Supinator 

Common flexor tendon 

Flexor digitorum superficialis 

Teres minor 

Pronator teres (ulnar head) 

Brachialis 

Latissimus dorsi Teres major 

(scapular part) 


Infraspinatus 

Deltoid 

Brachialis 


(medial head) 

Supinator 

(superficial head) 


Common 

extensor tendon 



Anconeus 

Supinator 

Origins 

Insertions 

Muscle attachments of the shoulder and arm 


407 


UPPER LIMB • Anterior compartment: muscles 

Clavicle 

Clavipectoral triangle 

Deltoid 

Clavicle 


Trapezius 

Acromion 


Median cubital 

vein 

Clavipectoral triangle 

Deltoid 




Surface anatomy of anterior compartment 



Anterior (flexor compartment) 


Posterior (extensor compartment) 

Medial 

intermuscular 

septum 

Humerus 

Brachialis 


Tendon of biceps brachii 


Bicipital aponeurosis 




Muscles of anterior compartment of arm 

408



and coracobrachialis 



Brachialis 


(from supraglenoid tubercle) 


Humerus 



Brachialis 


Scapula 

Humerus 

Muscle attachments of 

anterior compartment of arm 



Scapula 

Brachialis 

Tendon of biceps brachii 

Radius 


Brachialis 

Ulna 

Biceps brachii muscle 

Radius 

Deep muscles of anterior 

compartment of arm 

Ulna 

409

UPPER LIMB • Anterior compartment: arteries and nerves 









Scapula 


Humerus 







Lateral cord 


Radial recurrent 

artery 

Radius 

Radial artery 


Inferior ulnar collateral 

artery 

Anterior ulnar 

recurrent artery 


Posterior ulnar recurrent artery 

Medial cord 

Subscapularis 

Ulna 

Teres major 

Ulnar artery 

Common interosseous 

artery 


Median nerve 



Arteries of the arm (anterior view) 

Ulnar nerve 

Brachialis 

Radial nerve 

Nerves of the anterior compartment 


Lateral cutaneous nerve of forearm 


Ulnar nerve 

410


Supraspinatus 

Subclavian vein 

Cephalic vein 

Anterior circumflex humeral vein 

Posterior circumflex humeral vein 

Axillary vein 

Subscapularis 




Axillary vein 



Teres major 

Cephalic vein 

Paired brachial veins 

Radial 

recurrent vein 


Inferior ulnar collateral vein 


Anterior ulnar recurrent vein 

Posterior ulnar recurrent vein 


Deep veins of the arm 

Brachialis 

Basilic vein 

penetrates 

deep fascia 

Cephalic vein 

Superficial veins of the arm 


411

UPPER LIMB • Posterior compartment: muscles 

Deltoid 

Trapezius 



Lateral head 

of triceps 

brachii 

Deltoid 


Olecranon 

Infraspinatus 

Teres minor 

Teres major 

Surface anatomy of 

posterior compartment of arm 




Anterior 

(flexor compartment) 

Lateral 

intermuscular 

septum 

Brachialis 

Humerus 

Medial 

intermuscular 

septum 




Posterior 

(extensor compartment) 


Olecranon 

Extensor carpi ulnaris 


Anconeus 

Extensor carpi radialis brevis 


Muscles of posterior compartment of arm 

412


Humerus 

Scapula 


triceps brachii (cut) 


triceps brachii (cut) 


Radial groove 

Teres major 






Brachialis 





Radius 

Ulna 


Muscle attachments of 

posterior compartment of arm 

413

UPPER LIMB • Posterior compartment: arteries and nerves 

Supraspinatus 

Infraspinatus 

Teres minor 

Triangular space 

Posterior humeral circumflex artery 


Quadrangular space 

Triangular interval 

Teres major 

Long head of triceps brachii (cut) 




Acromion 


Radial nerve 

Lateral head of triceps 

brachii (cut) 




Scapula 

Branch to medial head 

of triceps brachii 




Humerus 

Ulnar nerve 




Recurrent 

interosseous 

artery 









Middle collateral artery 

Nerves and arteries of the 

posterior compartment 



Recurrent interosseous artery 

414 

Posterior ulnar recurrent artery 

Arteries of the arm (posterior view) 

Radial recurrent artery 

Anterior ulnar recurrent artery


Clavipectoral (deltopectoral) triangle 



Apical nodes 

Infraclavicular nodes 

Axillary vein 

Cephalic vein 

Median cubital 

vein 

Accessory 

cephalic vein 

Cephalic vein 

Basilic vein 

penetrates deep fascia 

Central nodes 


Basilic vein 

Humeral (lateral) nodes 

Subscapular (posterior) nodes 

Pectoral (anterior) nodes 

Cephalic vein 

Intermediate antebrachial vein 

Basilic vein 

Superficial veins of the arm and related fascia 

Cephalic vein 

Basilic vein 

Accessory cephalic vein 


Cubital nodes 

(supratrochlear 

or epitrochlear) 

Lymphatics of the arm 

415

UPPER LIMB • Transverse sections: arm 




Cephalic vein 




Deltoid 

Humerus 

Median nerve 

Radial nerve 

Intercostals 


Axillary vein 


Ulnar nerve 







A 


Cephalic vein 

Brachialis 

Humerus 



Teres major 


Median nerve 

Teres minor 


and veins 



Basilic vein 

Superior ulnar collateral 

artery and veins 

Ulnar nerve 

Rib 



B 

A 


(from profunda brachii artery) 

and vein 

Cephalic vein 




B 

Radial nerve 

Middle collateral artery (from profunda brachii artery) 



Brachial artery and veins 

Brachialis 

Median nerve 

C 

Radial nerve 







Basilic vein 

Ulnar nerve 

Transverse sections through arm 

416 

C 

Humerus 

Triceps brachii




Short head of biceps 

brachii 


Humerus 


Deltoid 

Teres major 



Subscapularis 

Scapula 

A 


Teres minor 

Infraspinatus 

Scapula 

Cephalic vein 


Brachialis 

Deltoid 

Humerus 




B 

Cephalic vein 


Brachialis 


Humerus 


Basilic vein 


C 

Transverse/axial sections through the arm. 

A. Proximal/upper arm. B. Middle arm. C. Distal/lower arm. 


417

UPPER LIMB • Anterior cutaneous nerves of the arm 


(from cervical plexus) 

C3,4 



(from axillary nerve) 

C5,6 



(from medial cord of 

brachial plexus) 

C8,T1 


T2 



(from radial nerve) 

C5,6 



(from medial cord 

of brachial plexus) 

C8,T1 



(from musculocutaneous 

nerve) 

C5,6 

Cutaneous nerves of the arm 



of arm 

C5,6 

Intercostobrachial 

nerve 

T2 


C3,4 


cutaneous nerves of the arm 



C5,6 


C8,T1 

C4 

C3 


C8,T1 

C5 

T2 

T3 


C5,6 

C6 

T2 

T4 

T5 

T6 

Dermatomes of the arm 

T1 

418



cutaneous nerves of the arm 

Cutaneous nerves of the arm 


C3,4 


(from cervical plexus) 

C3,4 



(from axillary nerve) 

C5,6 




C5,6,7,8 



(from medial cord of 

brachial plexus) 

C8,T1 




C5,6 


T2 




C5,6,7,8 

C3 

C4 




C5,6 



C5,6,7,8 



C5,6 


C8,T1 



(from medial cord 

of brachial plexus) 

C8,T1 




nerve) 

C5,6 

T2 

Posterior cutaneous nerve of forearm 

C5,6,7,8 

T3 

T4 

T5 


C8,T1 

T6 

C5 


C5,6 

T2 

T1 

Dermatomes of the arm 

C6 

419

UPPER LIMB • Elbow joint 

Humerus 

Humerus 

Lateral supraepicondylar 

(supracondylar) 

ridge 



Lateral 

epicondyle 

Medial 



Olecranon 

Humeroradial joint 

Capitulum 

Head 

Trochlea 

Coronoid process 

Humero-ulnar joint 

Elbow joint 

Head 

Neck 

Proximal 

radio-ulnar joint 

Neck 

Tuberosity of ulna 


Radial notch 

Radius 

Ulna 

Olecranon 

Ulna 

Radius 

Anterior view 

Proximal 

radio-ulnar joint 



(articular circumference) 

Trochlear notch 

Anular ligament 

Articular facet 

Radial notch 


Humerus 

Superior view 

Humerus 

Lateral supraepicondylar 

(supracondylar) 

ridge 

Capitulum 

Humeroradial joint 

Head 

Radius 

Medial supracondylar ridge 



Head 

Radius 

Medial 

epicondyle 

Lateral 

epicondyle 

Trochlea 

Olecranon 

Olecranon 


Radial notch 

Proximal radio-ulnar joint 

Ulna 

Ulna 


Lateral view 

Medial view 

420

Elbow joint 7 


Capitulum 

Humerus 

Humerus 

Lateral 

epicondyle 

Capitulum 

Medial 

epicondyle 

Trochlea 


Neck of radius 

Radius 

Ulna 



Olecranon 

Normal elbow joint. 




Capitulum 


Humerus 

Brachialis 

Humerus 

Brachialis 


Neck of radius Olecranon 

Ulna Trochlea 

Articulation of the capitulum of the humerus and the 

head of the radius at the elbow joint. 


Articulation of the trochlea of the humerus and the 

trochlear notch of the ulna. 


421

UPPER LIMB • Elbow joint: capsule and ligaments 

Humerus 

Humerus 

Fat pads 

Fat pad 

Lateral 

epicondyle 



Olecranon 




Sacciform recess of 

synovial membrane 

Sacciform recess of 

synovial membrane 

Radius 

Ulna 

Ulna 

Radius 

Synovial membrane of the elbow joint 


Synovial membrane of the elbow joint 


Humerus 

Humerus 



Lateral 

epicondyle 




Radial collateral 

ligament 


Olecranon 

Joint capsule 


ligament 


Ulnar collateral 

ligament 

Radius 

Ulna 

Ulna 

Radius 

Fibrous membrane of joint capsule and ligaments 

of the elbow joint (anterior view) 


of the elbow joint (posterior view) 

422




Fat pad 




Fat pad 

Sagittal section through the elbow joint 

(medial view) 


Olecranon 



ligament 




Fibrous membrane of 

joint capsule 


of the elbow joint (lateral view) 

Ulnar collateral ligament, 

anterior part 

Ulnar collateral ligament, oblique part 

Ulnar collateral ligament, 

posterior part 


of the elbow joint (medial view) 

Humerus 


Radial collateral ligament 

Ulnar collateral ligament 


Ulna 

Neck of radius 



423

UPPER LIMB • Cubital fossa 

Radial nerve 





nerve) 

Ulnar nerve 

Median nerve 


Radial nerve 



Humerus 



Cubital fossa 




(pulled back) 


radial nerve 

Supinator 


of radial nerve 


(ulnar head) 

Ulnar artery 

Median nerve 

Radial artery 




Position of the radial nerve 

Margins of the cubital fossa 


Median nerve 


Radial nerve 

Ulnar nerve 




nerve) 

Brachialis 



tendon 

Radial artery 

Ulnar nerve 


Median nerve 

Pronator 

teres 


Cephalic vein 

Posterior cutaneous nerve of 

forearm (from radial nerve) 







Cephalic vein 

Basilic vein 

Branches of medial 


of forearm 

Median antebrachial 

vein 

Median 

basilic vein 

Basilic vein 

Skin and 

subcutaneous 

tissue (cut) 

424 

Contents of the cubital fossa 

Superficial structures


Olecranon 


Head 

Neck 

Radial notch 

Humerus 

Coronoid 

process 

Anular 

ligament 

Tuberosity 

of ulna 


Oblique cord 


Oblique line 

Radius 

Ulna 


Interosseous 

borders 


Ulna 


Interosseous 

membrane 

Carpal bones 

Ulnar notch 

Radius and ulna. 


Radius 

Aperture for 

anterior 

interosseous 

artery 

Distal 

radio-ulnar 

joint 

Radial styloid 

process 

Radius (anterior view) 

Ulna (anterior view) 

Ulnar styloid process 

Wrist joint 




Transverse section 

(midforearm) 

Anterior surfaces 

Interosseous 

border 

Posterior surfaces 

Posterior border 

Radius, carpal articular surface 

Radial styloid process 



Distal radio-ulnar joint 

Ulnar notch 

Distal radio-ulnar joint and 

the interosseous membrane 

Head of ulna 


Dorsal tubercle 

Distal articular surface 

425

UPPER LIMB • Bones of the hand and wrist joint 

Digit IV 

Digit III 

Digit II 

Capitate 

Intermetacarpal joint 

Intercarpal ligament 

Trapezoid 

Digit V 

Distal phalanx II 

Carpometacarpal joint 

Hamate 

Middle phalanx II 

Proximal phalanx II 

Digit I (thumb) 

Pisiform 

Triquetrum 


Lunate 

Ulna 

Trapezium 

Midcarpal joint 

Scaphoid 

Wrist joint 

Radius 

Phalanges 

IV 

III 

II 

Distal phalanx I 

Proximal 

phalanx I 


Coronal section 

V 

Metacarpals 

Capitate 

I 



Hamate 

Carpal bones 

Pisiform 

Triquetrum 

Lunate 

Ulna 

Trapezium 

Trapezoid 


Scaphoid 


Radius 

II 

III 

Bones of the hand (palmar view) 

IV 

Proximal phalanx I 

V 

I 

Metacarpal I 

Capitate 

Trapezoid 

Hamate 

Distal row of 

carpal bones 

Proximal row of 

carpal bones 


Wrist joint 

Trapezium 

Scaphoid 

Pisiform 

Triquetrum 

Lunate 

Ulna 

Palmar view 

Radius 

Radius 

Ulna 

426 

Bones of the hand (dorsal view)


Metacarpal V 

Hamate 

Triquetrum 

Metacarpal III 

Metacarpal II 

Trapezoid 

Capitate 

Scaphoid 

Lunate 




Radius 

Ulna 

A 

Phalanges 



Metacarpal I 

Metacarpals 

Capitate 

Hamate 

Trapezoid 

Trapezium 

Scaphoid 


Radius 

Pisiform and triquetrum 

Carpal bones 

Lunate 


B 

Ulna 

Imaging of the wrist joint, the carpal bones, and the hand. 

A. T1-weighted MR image in coronal plane 

B. Radiograph, AP view 

427

UPPER LIMB • Bones of the hand 

Digit IV 

Digit III 

Tuberosity of distal phalanx 

Digit II 

Head of phalanx 

Shaft of phalanx 


Base of phalanx 

Digit V 



Digit I 


Head of metacarpal 

IV 

III 

II 

Metacarpal II 


V 

Shaft of metacarpal 

I 

Sesamoids 

Base of metacarpal 

Metacarpal I 

Hook of hamate 

Hamate 

Trapezium 

Pisiform 

Tubercle of 

trapezium 

Bones of the hand (anterior view) 

Triquetrum 

Lunate 

Capitate 

Trapezoid 

Tubercle of scaphoid 

Scaphoid 

Distal phalanges 

Middle phalanges 


trapezium 

Carpal arch 

Lunate 


Proximal phalanges 

Pisiform 

Trapezium 

Trapezoid 

Scaphoid 

Capitate 

Hamate 

Triquetrum 

Carpal bones 

Metacarpal bones 

Carpal bones (distal view; pronated) 

428


Deep transverse metacarpal ligaments 





Thumb 

(digit I) 

DIP joint 

MP joint 


Index finger 

(digit II) 

Middle finger 

(digit III) 

Ring finger 

(digit IV) 

Little finger 

(digit V) 

Carpometacarpal 

joints 

Palmar ligament 

Deep transverse metacarpal ligaments 


Pisometacarpal 

ligament 

Pisohamate 

ligament 

Pisiform 

Tendon of flexor 

carpi ulnaris 


ligament 

Palmar ulnocarpal 

ligament 

Ulna 

Palmar radioulnar ligament 

Radius 

Radiate carpal ligament 


flexor carpi 

radialis 

Palmar metacarpal ligaments 

Capsule of metacarpophalangeal 

joint of thumb 

Tubercle of trapezium 

Capitate 



Radial collateral ligament 

Palmar radiocarpal 

ligament 

Lunate 

Collateral 

ligaments 

Ligaments of the hand (palmar view) 


Collateral ligament 


Metacarpal Proximal phalanx Middle phalanx 


Interphalangeal joints (medial view) 



Trapezoid 

Capitate 


ligament 

Radius 

Ligaments of the hand (dorsal view) 

Dorsal 

carpometacarpal 

ligaments 

Hamate 

Dorsal intercarpal 

ligaments 

Triquetrum 

Dorsal radiocarpal 

ligament 


ligament 

Dorsal radioulnar 

ligament 

Ulna 

429

UPPER LIMB • Muscle attachments of forearm 


Brachialis 



Common extensor tendon 


Supinator 

(deep head) 






muscle (ulnar attachment of 

humero-ulnar head) 


(ulnar head) 

Brachialis 


Subcutaneous area 



Brachialis 

Common extensor 

tendon 

Supinator 


Anconeus 

Supinator 

(deep head) 


(radial head) 



profundus 




Abductor pollicis 

longus 


Ulna 

Radius 

Radius 


Ulna 


Extensor pollicis 

brevis 





longus 

Flexor carpi 

radialis 



Pisohamate ligament 

Pisometacarpal ligament 




Extensor carpi radialis 

longus 


longus 

Extensor 

pollicis 

brevis 

Flexor pollicis 

longus 


superficialis 

Extensor digiti 

minimi 


longus 


430 



Muscle attachments of forearm (anterior view) 

Origins 

Insertions 


Muscle attachments of forearm (posterior view)





Brachialis 


Brachialis 




Biceps brachii tendon 










tendon 


Flexor carpi ulnaris tendon 



Surface anatomy (anterior view) 



Flexor carpi radialis tendon 




Pisiform 

Palmar aponeurosis (cut) 

Intermuscular septum 



superficialis tendons 

Radius 


Ulna 


Flexor pollicis longus tendon 

Flexor digitorum profundus tendons 

Superficial layer of forearm muscles (anterior view) 

431

UPPER LIMB • Anterior compartment of forearm: muscles 


Brachialis 

Lateral 

epicondyle 


tendon 

Supinator 



Brachialis 




Ulnar artery 

Median nerve 


Radial artery 



Pronator teres (cut) 

Ulnar nerve 

Humeral head of 

pronator teres (cut) 

Palmaris 

longus (cut) 


flexor carpi ulnaris 

Ulnar head of 

pronator teres 



Palmaris longus (cut) 

Flexor carpi 

radialis (cut) 

Ulnar artery 

Median nerve 

Radius 






tendon 

Flexor 

retinaculum 




Pisiform 

Palmar aponeurosis (cut) 






Pisiform 



Metacarpal V 

Palmar aponeurosis 

Metacarpal II 

Flexor pollicis 

longus tendon 


profundus tendons 

432 

Superficial layer of forearm muscles (anterior view)


Lateral 

epicondyle 


Ulna 


Humero-ulnar head of 

flexor digitorum superficialis 


superficialis (cut) 

Radius 

Oblique cord 

Interosseous 

membrane 


Radial head of 

flexor digitorum 

superficialis 


Flexor digitorum superficialis (cut) 




Scaphoid 

Pisiform 

Pronator 

quadratus 

Trapezium 

Pisiform 

Metacarpal I 

Trapezium 

Trapezium 

Pisiform 

Tendons of the flexor digitorum 

superficialis and flexor digitorum 

profundus passing through the carpal 

tunnel into the hand. 


Flexor digitorum superficialis tendons (cut) 


Intermediate layer of forearm muscles (anterior view) 

Deep layer of forearm muscles (anterior view) 

433

UPPER LIMB • Anterior compartment of forearm: arteries and nerves 


Posterior 

cutaneous 

nerve of 

forearm (cut) 

(from radial 

nerve) 

Ulnar nerve 


(from medial cord of brachial plexus) 

Median nerve 





Inferior ulnar collateral artery 

Lateral 

cutaneous 

nerve of 

forearm (cut) 


nerve) 


tendon 

Radial artery 




Radial nerve 



Radial recurrent 

artery 

Deep branch 

radial nerve 

Radial artery 

Supinator 


radial nerve 


artery 

Posterior interosseous 

artery 

Interosseous 

membrane 

Pronator teres (cut) 


Median nerve 

Recurrent interosseous artery 

Ulnar nerve 


pronator teres (cut) 


Anterior ulnar 

artery 




Posterior ulnar 



pronator teres 

Ulnar artery 

Anterior interosseous 

nerve 


artery 

Radial artery 



superficialis (cut) 

Anterior 

ulnar 

recurrent 

artery 

Posterior 

ulnar 

recurrent 

artery 

Common 

interosseous 

artery 

Anterior 

interosseous 

artery 

Ulnar 

artery 

Radial artery 

Ulnar artery 


tendon 

Median nerve 

Perforating branches 

of anterior 

interosseous artery 

Ulnar nerve 



Radius 

Ulna 


Palmar branch of 

median nerve 

Palmar aponeurosis 

Brachioradialis tendon (cut) 


ulnar nerve 


Median nerve 


tendon (cut) 


Superficial palmar 

branch of radial artery 


median nerve 

Superficial palmar 

branch of radial artery 


ulnar nerve 

Flexor carpi ulnaris tendon (cut) 

Ulnar nerve 

Palmar branch of ulnar nerve 

Deep palmar branch of ulnar artery 




Pisiform 


434 

Arteries and nerves of forearm (anterior view)



Olecranon 



Ulnar nerve 

Olecranon 



Anconeus 

Flexor 

carpi ulnaris 






radialis brevis 

Extensor 

carpi ulnaris 




Extensor digiti minimi 



Anterior view 

Surface anatomy (posterior view) 



Intermuscular septum 


Extensor retinaculum 

Anconeus 



Radius 

Interosseous 

membrane 




Ulna 

Extensor 

digiti minimi 

Extensor 

digitorum 



longus tendon 

Superficial muscles of forearm 


Superficial layer of muscles in the 

posterior compartment of forearm 

435

UPPER LIMB • Posterior compartment of forearm: muscles 



(cut) 



Supinator 



Supinator 

(deep head) 

Supinator 


Supinator 

(deep head) 

Interosseous 

membrane 


Anterior view 



longus 



brevis tendon (cut) 




Supinator 


Supinator 

(deep head) 

(Superficial head 

of supinator 

originates from 

lateral epicondyle 

of humerus, 

radial collateral 

ligament, and 

anular ligament) 

Abductor 

pollicis longus 



Extensor 

pollicis brevis 


tendons (cut) 

Deep muscles of forearm 


Origin of deep layer of muscles in the 


436

Posterior compartment of forearm: arteries and nerves 7 

Medial 

epicondyle 

Ulnar nerve 



Flexor carpi 

ulnaris 

Extensor 

carpi ulnaris 

(pulled back) 



ulnar nerve 


Radial nerve 

Lateral 

epicondyle 



Deep branch 


Supinator 



Superficial 


radial nerve 

Posterior 

interosseous nerve 



Posterior 




(pulled back) 


minimi (pulled back) 




longus 



Anterior interosseous artery 


radial nerve 

Anterior view 




Ulnar nerve 

Medial intermuscular 

septum 






Supinator 

(deep head) 


artery 


artery 

Ulnar artery 






Recurrent interosseous 

artery 


Termination of anterior 


Dorsal carpal branch 

of ulnar artery 



Radial nerve 

Lateral 

intermuscular 

septum 

Supinator 

(superficial 

head) 

Posterior 

interosseous 

nerve 

(continuation 

of deep branch 

of radial nerve) 

Recurrent 

interosseous 

artery 

Posterior 

interosseous 

artery 

Abductor 

pollicis longus 

Extensor 

pollicis brevis 

Radial artery 

Ulna 

Posterior 

interosseous 

artery 


Arteries and nerves in the 


Interosseous 

membrane 

Radius 

Dorsal carpal artery 

Arteries and nerves in the 


Ulnar artery 



Dorsal carpal network 

Radial artery 

Dorsal carpal artery 

Arteries of the forearm (posterior view) 

437

UPPER LIMB • Transverse sections: forearm 

Biceps brachii tendon 

Lateral cutaneous nerve 

(from musculocutaneous nerve) 

Cephalic vein 



radial nerve 


radial nerve 


longus 

Supinator 

Median nerve 

Brachial artery and veins 


Brachialis 


Basilic vein 

Branches of medial 

cutaneous nerve of forearm 




Ulnar nerve 



Ulna 

A 

A 



Radius 

Anconeus 

Proximal radio-ulnar joint 

Median antebrachial vein 

Median nerve 




B 

Cephalic vein 

Ulnar artery and nerve 


Radial artery 


radial nerve 






Ulna 


Basilic vein 





C 

Radius 


438 


B 

C 



Flexor digitorum superficialis tendons 

Median nerve 



Radial artery 


radial nerve 

Cephalic vein 

Abductor pollicis longus tendon 

Extensor pollicis brevis tendon 

Brachioradialis tendon 

Extensor carpi radialis longus tendon 

Extensor carpi radialis brevis tendon 



Posterior interosseous vessels and nerve 



Flexor digitorum superficialis and tendon 

Ulnar artery and nerve 

Flexor carpi ulnaris and tendon 



Dorsal branch of ulnar nerve 


Ulna 

Extensor carpi ulnaris tendon 


Extensor digiti minimi tendon Transverse sections through forearm 


Extensor digitorum tendon


Brachialis 












Ulnar nerve 


Ulna 

Anconeus 

A 




Radial vessels 



Radius 





Radial vessels 



Radius 





B 



Ulna 










Flexor digitorum profundus tendon 

Ulna 

Extensor indicis tendon 


Extensor digiti minimi tendon 

C 


Transverse/axial sections through the forearm. 

A. Proximal/upper forearm. T1-weighted MR image in axial plane 

B. Middle forearm. T1-weighted MR image in axial plane 

C. Distal/lower forearm. Fat-saturated proton density MR image in axial plane 

439

UPPER LIMB • Carpal tunnel 



For tendon of flexor carpi radialis 

Hook of 

hamate 

Pisiform 

Pisiform 


trapezium 


scaphoid 

Triquetrum 


trapezium 

Trapezium 

Hamate 

Capitate 

Trapezoid 

Carpal arch 

Digit III 

(middle finger) 

Digit IV 

(ring finger) 

Digit II 

(index finger) 

Digit V 

(little finger) 


Median nerve 

Digit I 

(thumb) 


Thenar muscle 

Ulnar artery 

Ulnar nerve 




Basilic vein 

Extensor digiti minimi tendon 

Extensor digitorum tendon 

Cephalic vein 

Radial artery 




Extensor indicis muscle 





Carpal tunnel, structures and relations 

440





Pisiform 

Triquetrum 

Median nerve 





Scaphoid 

Lunate 

A 


Median nerve 






Hamate 

Tubercle of trapezium 


Trapezium 

Trapezoid 

Capitate 

B 


Median nerve 







Hamate 


Trapezium 

Trapezoid 

Capitate 

C 

Transverse/axial sections through the carpal tunnel. 

A. Proximal end of carpal tunnel. 

B. Middle portion of carpal tunnel. 

C. Distal portion of carpal tunnel. 


441

UPPER LIMB • Muscle attachments of the hand 



Adductor pollicis 




a. 

b. 

c. 

d. 

e. 

f. 

g. 

h. 

First palmar interosseous* 


Second palmar interosseous 



Third palmar interosseous 


Fourth palmar interosseous 

(* see page 447) 

Interossei 

Abductor 

digiti minimi 

Opponens 

digiti minimi 

g 

h 

e 

f 

c 

d 

b 

Adductor 

pollicis 

Flexor pollicis brevis and abductor 


Flexor digiti 

minimi 


(via pisometacarpal 

ligament) 



a 

Flexor carpi 

radialis 


longus 

Opponens 

pollicis 

Extensor 

indicis 


minimi 

Adductor pollicis (oblique head) 

Flexor pollicis brevis 

Opponens pollicis 

Abductor pollicis brevis 

Interossei 

Muscle attachments (palmar view) 


Dorsal 

interossei 




minimi 

Opponens 

digiti minimi 

Extensor 

carpi ulnaris 




Origins 

Insertions 

442 


Muscle attachments (dorsal view)


Longitudinal fibers of palmar aponeurosis 


metacarpal ligament 

Distal commissural 

ligament 

Transverse fibers of palmar aponeurosis 

Palmaris brevis 

Distal 

interphalangeal 

joint crease 

Proximal 

interphalangeal 

joint crease 

Proximal commissural 

ligament 

Metacarpophalangeal 

joint crease 

Deep fascia of forearm 

Distal transverse 

crease 

Hypothenar 

eminence 

Proximal 

transverse 

crease 



tendon 

Thenar eminence 

Palmar aponeurosis (palmar view) 

Distal wrist crease 

Proximal wrist crease 


Surface anatomy (palmar view) 

443

UPPER LIMB • Tendon sheaths of hand 


Deep transverse metacarpal ligament 

Fibrous digital sheaths 


Flexor digitorum superficialis tendon 

Cruciform ligament 


First lumbrical 



synovial sheath 

Flexor digiti minimi 

Opponens digiti minimi 









Synovial sheath of flexor 

pollicis longus tendon 

Common flexor tendon sheath 









superficialis tendon 


A1 

Superficial muscles of the hand (palmar view) 

A2 

C1 A3 C2 A4 C3 A5 


profundus tendon 

444 



Fibrous digital sheath and synovial sheath 

Anular ligaments (A), cruciform ligaments (C)



Flexor digitorum superficialis tendon (cut) 



Attachment to dorsal hood 


Third and fourth lumbricals 

(bipennate) 





First and second lumbricals 

(unipennate) 






Lumbrical muscles (palmar view) 




Metacarpal V 

Metacarpal IV 



Metacarpal I 


Metacarpal II 


Imaging of the proximal portion of the hand. 


445

UPPER LIMB • Intrinsic muscles of hand 

Thenar eminence 

Hypothenar eminence 


profundus tendon (cut) 

Flexor digitorum superficialis tendon (cut) 


Lumbricals (cut) 

Second dorsal 

interosseous 

Second palmar interosseous 









Pisiform 




Flexor pollicis brevis (cut) 

Abductor pollicis brevis (cut) 


Adductor pollicis (transverse head) 

Extensor hood 



Flexor retinaculum (cut) 

Capitate 

Ulna 

Radius 

446 

Deep muscles of the hand (palmar view)






Adductor pollicis (cut) 



Second palmar 

interosseous 


(cut) 

Flexor digiti minimi brevis (cut) 









First palmar interosseous* 


Opponens pollicis (cut) 



Capitate 

Deep muscles of the hand (palmar view) 

Abduction Abduction Adduction Adduction 

Insertion into base of 

dorsal hood 

Insertion into base 

of metacarpal 

Insertion into 

dorsal hood 

4 

3 

2 

1 

4 

3 

2 

* 

1 

Dorsal interossei (palmar view) 

Dorsal interosseous 

(bipennate) 

(* Rudimentary: when present is often 

considered part of either adductor 

pollicis or flexor pollicis brevis) 

Palmar interossei (palmar view) 

Palmar interosseous 

(unipennate) 

447

UPPER LIMB • Palmar region (palm) of hand: arteries and nerves 

Proper palmar digital arteries and nerves 

Radialis indicis artery 

Branches of median nerve 

to first and second lumbricals 

Common palmar digital arteries 


Palmar metacarpal artery 


Palmar digital artery 

Common palmar digital nerve 


Branch of superficial branch of ulnar 

nerve to palmaris brevis (cut) 



Superficial branch of ulnar nerve 

Deep branches of ulnar artery and nerve 

Palmar branch of ulnar nerve (cut) 

Ulnar nerve 

Ulnar artery 


Recurrent branch of median nerve 


Median nerve 


Radial artery 


Proper palmar digital 

arteries and nerves 

of the thumb 



Common palmar digital nerves 


Palmar branch of median nerve (cut) 

Superficial branch of radial artery 

Superficial arteries and nerves of the hand (palmar view) 

448


Proper palmar digital arteries 

Deep transverse metacarpal ligament 

Common palmar digital arteries 




Branches of ulnar nerve 

to third and fourth lumbricals 

Palmar metacarpal arteries 


Third and fourth palmar interossei 

Deep branch of ulnar nerve 

Princeps pollicis 

artery 

Proper palmar digital 

arteries of the thumb 




Deep branches of ulnar artery and nerve 



Adductor pollicis (cut) 




Ulnar nerve 

Ulnar artery 

Median nerve 


Radial artery 

Deep arteries and nerves of the hand (palmar view) 

449

UPPER LIMB • Arteries of the hand 

Proper palmar digital arteries 

Proximal 

transverse 

skin crease 

Distal transverse skin crease 

Superficial 

palmar arch 

Pisiform 

Deep 

palmar arch 

Distal wrist crease 

Ulnar artery 

Radial artery 


Common palmar 

digital arteries 


Palmar metacarpal arteries 

Princeps pollicis artery 



Deep branch of ulnar artery 

Pisiform 

Trapezium 

Mainly ulnar artery 

Mainly radial artery 


Ulnar artery 

Ulna 

Radial artery 

Radius 

450 

Arteries of the hand (palmar view)


Medial two lumbricals 

innervated by ulnar nerve 

Proper palmar digital nerves (median nerve) 

Cutaneous innervation 

of the median nerve in the hand 


of the dorsal branch of 

the ulnar nerve 


of the palmar branch of 

the median nerve 

Palmar view 

Lateral two lumbricals 

innervated by median nerve 

Dorsal view 

Proper palmar 

digital nerve 

(ulnar nerve) 

Intrinsic muscles 

innervated by 

ulnar nerve except 

the thenar muscles 

and the two lateral 

lumbricals 

Common palmar 

digital nerve 

Hypothenar 

muscles 

innervated by 

ulnar nerve 


Deep branch of the 

ulnar nerve 

Superficial branch of the 

ulnar nerve 

Palmar branch of the 

ulnar nerve 

Ulnar nerve 

Ulna 

Palmar branch of the 

median nerve 

Median nerve 

Radius 

Common palmar digital nerves 

(median nerve) 


of the superficial branch of 

the ulnar nerve in 

the hand 


innervated by median nerve 



of the palmar branch of 

the ulnar nerve 

Palmar view 


of the median nerve in the hand 

Innervation of the hand, median and ulnar nerves 

(palmar view) 

Dorsal view 

451

UPPER LIMB • 

Dorsum of hand 

Tendons of the extensor muscles of 

the forearm crossing the wrist joint 

and passing onto the dorsal 

surface of the hand. 



Capitate 

Metacarpal IV 


tendons 

Hypothenar 

eminence 


longus tendon 

Styloid process of 

ulna 

Intertendinous connections 

Surface anatomy (dorsal view) 


Adductor pollicis and first 

palmar interosseous* insert into 

extensor hood 








Second, third, and fourth 

dorsal interossei 



Synovial sheaths 


Ulna 

Radius 




452 

Superficial structures of the hand (dorsal view) 

(* see page 447)

Dorsal hoods 

77 

Insertion of extensor digitorum 

to base of distal phalanx 


to base of middle phalanx 


Second, third, and 

fourth dorsal 

interossei 

Distal 

interphalangeal joint 

Triangular aponeurosis 

First dorsal 

interosseous* 

Proximal 

interphalangeal joint 

Lateral bands 

Lumbrical slip 

Interosseous slip 

Central slip 

First palmar 

interosseous 

Extensor 

digitorum tendons 

Lumbricals 



Extensor hood 















Metacarpal II 

Third dorsal 

interosseous 

Metacarpal IV 


tendon 

Extensor tendons (dorsal view) 

(* see page 447) 

Lateral band 


to base of distal phalanx 


to base of middle phalanx 

Lumbrical slip 

Extensor hood 

Interosseous slip 

Dorsal view (digit III) 

Insertion into proximal phalanx 

Extensor digitorum tendon 






Vincula breve 


Vincula longa 

Lateral view (digit III) 




Second lumbrical 


Insertion into extensor hood 

453

UPPER LIMB • Dorsum of hand: arteries 

Dorsal branches of 

proper palmar digital arteries 



Arteries of the hand (dorsal view) 

Extensor digitorum tendons (cut) 

Dorsal metacarpal arteries 

First dorsal 

metacarpal artery 



Radial artery in 

anatomical snuffbox 


Dorsal carpal arch 



First dorsal 

interosseous 





Dorsal digital artery to next digit 

Dorsal 

carpal arch 

Dorsal branches of 

proper palmar digital arteries 

Metacarpophalangeal joint 


Dorsal metacarpal artery 

Radial artery 

Dorsal carpal 

network 

Dorsal carpal 


ulnar artery 

Arteries of the digit 

Proper palmar digital artery 

Proper palmar digital artery to next digit 

Palmar metacarpal artery 

Common palmar digital artery 

Posterior 

interosseous 

artery 

454


Dorsal digital nerves 

from median nerve Dorsal digital nerve Dorsal digital nerve to next digit 

Palmar digital nerve 

Metacarpophalangeal joint 



the radial nerve 

Nerves of the digit 

Dorsal view 


of superficial branch 

of median nerve 


from ulnar nerve 






the radial nerve 

Palmar view 



the median nerve 



of median nerve 

Anatomical snuffbox 


ulnar nerve 

Dorsal view 


radial nerve 


(branch of radial nerve) 


Nerves of the hand (dorsal view) 



(terminal part of 

musculocutaneous 

nerve) 

Dorsal view 


of the dorsal branch of the 

ulnar nerve 

455

UPPER LIMB • Anatomical snuffbox 


Anatomical snuffbox 


Proper palmar digital nerve 

(median nerve) 





Skin and subcutaneous 

tissue (cut) 

First lumbrical 






Dorsal digital nerves of 

superficial branch of 

radial nerve 




Metacarpal II 

Dorsal metacarpal artery 

Dorsal metacarpal vein 


Dorsal 

venous 

network 

Metacarpal I 

Scaphoid 

Radial artery 


Superficial palmar branch 

of radial artery 



of the radial nerve 

Radial artery 



Deep fascia (cut) 


Dorsal carpal branch of radial artery 


Styloid process of radius 




Cephalic vein 

Superficial branch of the radial nerve 

Deep fascia 


(branch of radial nerve) 

Anatomical snuffbox (lateral view) 

456


Cephalic vein 

Basilic vein 


Cubital nodes 

(supratrochlear or epitrochlear) 

Intermediate basilic vein 


Intermediate antebrachial vein 


Cephalic vein 

Basilic vein 

Perforating veins 

Cephalic vein 

Basilic vein 

Dorsal venous network 

Lymphatic vessels passing 

to dorsum of hand 

Dorsal metacarpal veins 

Palmar digital 

veins 

Dorsal digital veins 

Dorsal digital veins 

Superficial veins and lymphatics of the forearm (palmar view) 

Superficial veins of the forearm (dorsal view) 

457

UPPER LIMB • Anterior cutaneous nerves of forearm 



C5,6 


T2 



C8,T1 


T2 



C5,6 



C5,6 T2 

C5 



C8,T1 

Superficial 

branch of radial 

C7,8 



C5,6 

Palmar branch of median 

Palmar branch of ulnar 

T1 

C6 

Superficial 


C7,8 

Ulnar 

C8,T1 

Ulnar 

C8,T1 

Median 

C6,7,8 

Cutaneous nerves of the forearm 

Median 

C6,7,8 

C8 

C7 


cutaneous nerves of the forearm 

Dermatomes of the forearm 

458




C5,6,7,8 

T2 

C5 




C5,6 



C5,6,7,8 



C5,6 


T2 



C8,T1 


T2 



C5,6 



C8,T1 



C5,6,7,8 



C5,6,7,8 



C8,T1 



C5,6 

T1 



C8,T1 



C5,6 

Superficial 


C6,7,8 

C6 


ulnar C8,T1 

Superficial 


C6,7,8 

C8 

Ulnar 

C8,T1 

C7 

Median 

C6,7,8 

Cutaneous nerves of the upper limb 

Dermatomes of the upper limb 

Median 

C6,7,8 


cutaneous nerves of the upper limb 

459

UPPER LIMB • Tables 

Branches of the brachial plexus 

Branch 

Origin 



Function: sensory 


1 

C5 root 

C5 

Rhomboid major, rhomboid 

minor 

Long thoracic 

2 

C5 to C7 roots 

C5 to C7 


Suprascapular 

3 


C5, C6 

Supraspinatus, 

infraspinatus 


4 


C5, C6 

Subclavius 

Lateral pectoral 

5 

Lateral cord 

C5 to C7 


Musculocutaneous 

6 

Lateral cord 

C5 to C7 

All muscles in the anterior 

compartment of the arm 

Skin on lateral side of forearm 


7 

Medial cord 

C8, T1 (also receives 

contributions from spinal 

segments C5 to C7 through 

a communication with the 

lateral pectoral nerve) 

Pectoralis major, pectoralis 

minor 



8 

Medial cord 

Spinal segments: C8, T1 

Skin on medial side of distal 

one third of arm 


of forearm 

9 

Medial cord 

C8, T1 

Skin on medial side of forearm 

Median 

10 


cords 

(C5), C6 to T1 

All muscles in the anterior 

compartment of the forearm 

(except flexor carpi ulnaris 

and medial half of flexor 

digitorum profundus), three 

thenar muscles of the 

thumb, and two lateral 

lumbrical muscles 

Skin over the palmar surface 

of the lateral three and one half 

digits and over the lateral side 

of the palm and middle of the 

wrist 

Ulnar 

11 

Medial cord 

(C7), C8, T1 

All intrinsic muscles of the 

hand (except three thenar 

muscles and two lateral 

lumbricals); also flexor 

carpi ulnaris and the medial 

half of flexor digitorum 

profundus in the forearm 

Skin over the palmar surface 

of the medial one and one half 

digits and associated palm and 

wrist, and skin over the dorsal 

surface of the medial one and 

one half digits 

Superior 

subscapular 

12 


C5, C6 

Subscapularis 

Thoracodorsal 

13 


C6 to C8 


460

Tables 7 

Branches of the brachial plexus 

Branch 

Origin 



Function: sensory 

Inferior 

subscapular 

14 


C5, C6 

Subscapularis, teres major 

Axillary 

15 


C5, C6 

Deltoid, teres minor 

Skin over upper lateral part 


Radial 16 


C5 to C8, (T1) 

All muscles in the posterior 

compartments of arm and 

forearm 

Skin on the posterior aspects 

of the arm and forearm, the 

lower lateral surface of the 

arm, and the dorsal lateral 

surface of the hand 

1 

3 

5 

4 

6 

15 

10 

14 

13 

12 

2 

16 

7 

11 

9 

8 

461

Tables 7 

Muscles of the posterior scapular region 



Supraspinatus 

1 Medial two thirds of the 

supraspinous fossa of the 

scapula and the deep fascia 

that covers the muscle 

Most superior facet on the 

greater tubercle of the 

humerus 

Suprascapular 

nerve [C5, C6] 

Rotator cuff muscle; 

initiation of abduction of 

arm to 15° at glenohumeral 

joint 

Infraspinatus 

2 Medial two thirds of the 

infraspinous fossa of the 

scapula and the deep fascia 

that covers the muscle 

Middle facet on posterior 

surface of the greater tubercle 

of the humerus 

Suprascapular 


Rotator cuff muscle; lateral 

rotation of arm at the 

glenohumeral joint 

Teres minor 

3 Upper two thirds of a flattened 

strip of bone on the posterior 

surface of the scapula 

immediately adjacent to the 

lateral border of the scapula 

Inferior facet on the posterior 

surface of the greater tubercle 



[C5, C6] 

Rotator cuff muscle; lateral 

rotation of arm at the 


Teres major 

4 Elongate oval area on the 

posterior surface of the 

inferior angle of the scapula 

Medial lip of the intertubercular 

sulcus on the anterior surface 


Inferior subscapular 

nerve [C5, C6, C7] 

Medial rotation and 

extension of the arm at the 




5 Infraglenoid tubercle on 

scapula 

Common tendon of insertion 

with medial and lateral heads 

on the olecranon process of 

ulna 

Radial nerve 

[C6, C7, C8] 

Extension of the forearm at 

the elbow joint; accessory 

adductor and extensor of 

the arm at the glenohumeral 

joint 

1 

3 

4 

5 

2 

463


Muscles of the anterior wall of the axilla 



Pectoralis 

major 

1 Clavicular head—anterior 

surface of medial half of 

clavicle; sternocostal head— 

anterior surface of sternum; first 

seven costal cartilages; sternal 

end of sixth rib; aponeurosis of 

external oblique 

Lateral lip of 

intertubercular sulcus of 

humerus 


pectoral nerves; 

clavicular head 

[C5, C6]; sternocostal 

head [C6, C7, C8, T1] 

Flexion, adduction, and 

medial rotation of arm at 

glenohumeral joint; 

clavicular head—flexion of 

extended arm; sternocostal 

head—extension of flexed 

arm 

Subclavius 

2 

First rib at junction between rib 

and costal cartilage 

Groove on inferior surface 

of middle one third of 

clavicle 


[C5, C6] 

Pulls tip of shoulder down; 

pulls clavicle medially to 

stabilize sternoclavicular joint 

Pectoralis 

minor 

3 

Anterior surfaces and superior 

borders of ribs III to V; and 

from deep fascia overlying the 

related intercostal spaces 

Coracoid process of 

scapula (medial border 

and upper surface) 


[C5, C6, C7, C8, T1] 

Pulls tip of shoulder down; 

protracts scapula 

Muscles of the medial wall of the axilla 

Serratus 

anterior 

4 

Lateral surfaces of upper 8–9 

ribs and deep fascia overlying 

the related intercostal spaces 

Costal surface of medial 

border of scapula 


[C5, C6, C7] 

Protraction and rotation of the 

scapula; keeps medial border 

and inferior angle of scapula 

opposed to thoracic wall 

Muscles of the lateral and posterior wall of the axilla 

(spinal segments enclosed in parentheses do not consistently innervate the muscle) 

Subscapularis 

5 

Medial two thirds of subscapular 

fossa 

Lesser tubercle of 

humerus 

Upper and lower 

subscapular nerves 

[C5, C6, (C7)] 

Rotator cuff muscle; medial 

rotation of the arm at the 


Teres major 

6 

Elongate oval area on the 

posterior surface of the inferior 

angle of the scapula 

Medial lip of the 

intertubercular sulcus on 

the anterior surface of the 

humerus 

Lower subscapular 

nerve [C5, C6, C7] 

Medial rotation and 

extension of the arm at the 


Latissimus 

dorsi 

7 

Spinous processes of lower six 

thoracic vertebrae and related 

interspinous ligaments; via the 

thoracolumbar fascia to the 

spinous processes of the lumbar 

vertebrae, related interspinous 

ligaments, and iliac crest; lower 

3–4 ribs 

Floor of intertubercular 

sulcus 


[C6, C7, C8] 

Adduction, medial rotation, 

and extension of the arm at 

the glenohumeral joint 



8 

Infraglenoid tubercle on scapula 

Common tendon of 

insertion with medial and 

lateral heads on the 

olecranon process of ulna 

Radial nerve 

[C6, C7, C8] 


the elbow joint; accessory 

adductor and extensor of the 

arm at the glenohumeral joint 

464

Tables 7 

Muscles having parts that pass through the axilla 




1 Long head—supraglenoid 

tubercle of scapula; short 

head—apex of coracoid 

process 

Tuberosity of radius 


[C5, C6] 

Powerful flexor of the forearm at 

the elbow joint and supinator of 

the forearm; accessory flexor of 

the arm at the glenohumeral joint 

Coracobrachialis 2 Apex of coracoid process Linear roughening on Musculocutaneous nerve 

midshaft of humerus [C5, C6, C7] 

on medial side 

Flexor of the arm at the 

glenohumeral joint; adducts arm 

2 

1 

3 

4 

5 

9 

8 

10 

7 

6 

465


Muscles of the anterior compartment of the arm 




1 Apex of coracoid process Linear roughening on 

midshaft of humerus 

on medial side 


[C5, C6, C7] 

Flexor of the arm at the 



2 

Long head— 

supraglenoid tubercle of 

scapula; short head— 

apex of coracoid process 



[C5, C6] 

Powerful flexor of the forearm 

at the elbow joint and 

supinator of the forearm; 

accessory flexor of the arm at 

the glenohumeral joint 

Brachialis 

3 

Anterior aspect of humerus 

(medial and lateral 

surfaces) and adjacent 

intermuscular septae 

Tuberosity of the ulna 


[C5, C6]; (small contribution 

by the radial nerve [C7] to 

lateral part of muscle) 

Powerful flexor of the forearm 

at the elbow joint 

Muscle of the posterior compartment of the arm 


4 Long head—infraglenoid 

tubercle of scapula; medial 

head—posterior surface of 

humerus; lateral head— 


of humerus 

Olecranon 

Radial nerve [C6, C7, C8] 


the elbow joint. Long head 

can also extend and adduct 

the arm at the shoulder joint 

466

Tables 7 

1 

2 3 

4 

467


Superficial layer of muscles in the anterior compartment of the forearm 

(spinal segments indicated in bold are the major segments innervating the muscle) 


Flexor carpi 

ulnaris 

1 Humeral head—medial 

epicondyle of humerus; 

ulnar head—olecranon and 

posterior border of ulna 

Pisiform bone, and then 

via pisohamate and 

pisometacarpal ligaments 

into the hamate and base 

of metacarpal V 

Ulnar nerve [C7, C8, T1] 

Flexes and adducts the wrist joint 

Palmaris 

longus 

2 Medial epicondyle of 

humerus 

Palmar aponeurosis of 

hand 

Median nerve [C7, C8] 

Flexes wrist joint; because the 

palmar aponeurosis anchors skin 

of the hand, contraction of the 

muscle resists shearing forces 

when gripping 

Flexor carpi 

radialis 

3 Medial epicondyle of 

humerus 

Base of metacarpals II 

and III 


Flexes and abducts the wrist 

Pronator 

teres 

4 Humeral head—medial 

epicondyle and adjacent 

supracondylar ridge; ulnar 

head—medial side of 

coronoid process 

Roughening on lateral 

surface, midshaft, of 

radius 


Pronation 

Intermediate layer of muscles in the anterior compartment of the forearm 

Flexor 

digitorum 

superficialis 

5 

Humero-ulnar head— 

medial epicondyle of 

humerus and adjacent 

margin of coronoid process; 

radial head—oblique line of 

radius 

Four tendons, which 

attach to the palmar 

surfaces of the middle 

phalanges of the index, 

middle, ring, and little 

fingers 

Median nerve [C8, T1] 

Flexes proximal interphalangeal 

joints of the index, middle, ring, 

and little fingers; can also flex 

metacarpophalangeal joints of the 

same fingers and the wrist joint 

Deep layer of muscles in the anterior compartment of the forearm 

Flexor 

digitorum 


6 

Anterior and medial 

surfaces of ulna and 

anterior medial half of 

interosseous membrane 

Four tendons, which 

attach to the palmar 

surfaces of the distal 



fingers 

Lateral half by 

median nerve (anterior 

interosseous nerve); 

medial half by ulnar 

nerve [C8, T1] 

Flexes distal interphalangeal 

joints of the index, middle, ring, 

and little fingers; can also flex 

metacarpophalangeal joints of 

the same fingers and the wrist 

joint 

Flexor 

pollicis 

longus 

7 

Anterior surface of 

radius and radial half of 

interosseous membrane 

Palmar surface of base 

of distal phalanx of 

thumb 

Median nerve (anterior 

interosseous nerve) 

[C7, C8] 

Flexes interphalangeal joint of 

the thumb; can also flex 

metacarpophalangeal joint of the 

thumb 

Pronator 

quadratus 

8 

Linear ridge on distal 

anterior surface of ulna 

Distal anterior surface 

of radius 

Median nerve (anterior 

interosseous nerve) 

[C7, C8] 

Pronation 

468

Tables 7 

1 2 3 4 

5 6 

7 

8 

469


Superficial layer of muscles in the posterior compartment of the forearm 




1 Proximal part of lateral 

supracondylar ridge of 

humerus and adjacent 

intermuscular septum 

Lateral surface of distal end 

of radius 

Radial nerve [C5, C6] 

before division into 

superficial and deep 

branches 

Accessory flexor of 

elbow joint when 

forearm is midpronated 



2 

Distal part of lateral supracondylar 

ridge of humerus and 

adjacent intermuscular septum 


metacarpal II 

Radial nerve [C6, C7] 

before division into 

superficial and deep 

branches 

Extends and abducts 

the wrist 



3 

Lateral epicondyle of humerus 

and adjacent intermuscular 

septum 


metacarpals II and III 

Deep branch of radial 

nerve [C7, C8] before 

penetrating supinator 

muscle 

Extends and abducts 

the wrist 

Extensor 

digitorum 

4 



septum and deep fascia 

Four tendons, which insert 

via extensor hoods into the 

dorsal aspects of the bases 

of the middle and distal 



fingers 



Extends the index, 


fingers; can also extend 

the wrist 


minimi 

5 



septum together with extensor 

digitorum 

Extensor hood of the little 

finger 



Extends the little finger 


ulnaris 

6 


and posterior border of ulna 

Tubercle on the base of the 

medial side of metacarpal V 



Extends and adducts 

the wrist 

Anconeus 7 Lateral epicondyle of humerus Olecranon and proximal 

posterior surface of ulna 

Radial nerve [C6, C7, 

C8] (via branch to 

medial head of triceps 

brachii) 

Abduction of the ulna in 

pronation; accessory 

extensor of the elbow 

joint 

1 

2 

3 

4 

5 

6 

7 

470

Tables 7 

Deep layer of muscles in the posterior compartment of the forearm 



Supinator 

1 Superficial part—lateral epicondyle 

of humerus, radial collateral and 

anular ligaments; deep part— 

supinator crest of the ulna 

Lateral surface of 

radius superior to the 

anterior oblique line 



Supination 

Abductor 

pollicis 

longus 

2 

Posterior surfaces of ulna 

and radius (distal to the attachments 

of supinator and anconeus) and 

intervening interosseous membrane 


metacarpal I 



Abducts carpometacarpal joint 

of thumb; accessory extensor 

of the thumb 

Extensor 

pollicis 

brevis 

3 

Posterior surface of radius (distal to 

abductor pollicis longus) and the 

adjacent interosseous membrane 

Dorsal surface of base 

of proximal phalanx of 

the thumb 



Extends metacarpophalangeal 

joint of the thumb; can also 

extend the carpometacarpal 

joint of the thumb 

Extensor 

pollicis 

longus 

4 

Posterior surface of ulna (distal to 

the abductor pollicis longus) and the 


Dorsal surface of base 

of distal phalanx of 

thumb 



Extends interphalangeal joint 

of the thumb; can also extend 

carpometacarpal and 

metacarpophalangeal joints of 

the thumb 

Extensor 

indicis 

5 

Posterior surface of ulna (distal to 

extensor pollicis longus) and 


Extensor hood of index 

finger 



Extends index finger 

1 

4 

2 

5 

3 

471


Intrinsic muscles of the hand 


Muscle 

Origin 

Insertion 

Innervation 

Function 


1 

Palmar aponeurosis and 

flexor retinaculum 

Dermis of skin on the 

medial margin of the hand 


the ulnar nerve [C8, 

T1] 

Improves grip 


(four muscles) 

2 

Adjacent sides of 

metacarpals 

Extensor hood and base 


index, middle, and ring 

fingers 

Deep branch of ulnar 


Abduction of index, 

middle, and ring 

fingers at the 

metacarpophalangeal 

joints 

Palmar interossei 


3 

Sides of metacarpals 

Extensor hoods of the 

thumb, index, ring, and 

little fingers and the 

proximal phalanx of 

thumb 



Adduction of the 

thumb, index, ring, 

and little fingers at the 


joints 


4 

Transverse head— 

metacarpal III; oblique 

head—capitate and 

bases of metacarpals II 

and III 

Base of proximal phalanx 

and extensor hood of 

thumb 



Adducts thumb 

Lumbricals 


5 

Tendons of flexor 

digitorum profundus 

Extensor hoods of index, 

ring, middle, and little 

fingers 

Medial two by the 

deep branch of the 

ulnar nerve; lateral 

two by digital 


median nerve 

Flex metacarpophalangeal 

joints while 

extending interphalangeal 

joints 



6 

Tubercle of trapezium and 


Lateral margin and 

adjacent palmar surface 

of metacarpal I 


median nerve [C8, T1] 

Medially rotates thumb 


7 

Tubercles of scaphoid and 

trapezium and adjacent 


Proximal phalanx and 

extensor hood of thumb 



Abducts thumb at 


joint 


8 

Tubercle of the trapezium 

and flexor retinaculum 

Proximal phalanx of the 

thumb 



Flexes thumb at 


joint 



9 

Hook of hamate and flexor 

retinaculum 

Medial aspect of 

metacarpal V 



Laterally rotates 

metacarpal V 


10 

Pisiform, the pisohamate 

ligament, and tendon of 


Proximal phalanx of little 

finger 



Abducts little finger at 


joint 


11 

Hook of the hamate and 


Proximal phalanx of little 

finger 



Flexes little finger at 


joint 

472

Tables 7 

1 

2 

3 

4 

5 

6 

7 

9 

8 10 

11 

473


8 

CONTENTS 

HEAD AND NECK 





Skull: posterior view 482 


Skull: inferior view 484 


Ethmoid, lacrimal bone, inferior concha, and vomer 486 



Scalp and meninges 490 


Dural arteries and nerves 492 


Brain 494 






Vasculature, facial nerve [VII], and lymphatics 506 


Bony orbit 508 


Eyelids and lacrimal apparatus 510 


Muscles of the eyeball 512 


Eye movements 514 


Eyeball 516 

Eye imaging 517 

Ear surface and sensory innervation 520 

Ear 521 

Middle ear 522 

Internal ear 524 

Ear imaging 525 




Temporomandibular joint 530 


Parasympathetic innervation 532 

Arteries and veins of temporal and infratemporal fossae 533 


Neck surface anatomy 536 


Compartments and fascia of the neck 538 



Nerves in the neck 542 






Pharynx 552 


Innervation of the pharynx 556 


Larynx 558 

Laryngeal cavity 560 


Innervation of the larynx 562 



Nose and paranasal sinuses 566 


Nasal cavity: mucosal linings 568 



Oral cavity: bones 572 

Teeth 573 

Teeth: imaging 574 


Vessels and nerves supplying teeth 576 


Muscles and salivary glands of the oral cavity 578 


Tongue 580 


Palate 582 



Visceral motor pathways in the head 586 

Tables 588

HEAD AND NECK • Surface anatomy with bones 

Frontal bone 

Nasion 

Frontal bone Pterion Vertex 

Parietal bone 

Supra-orbital margin 

Frontozygomatic suture 

Glabella 

Zygomatic arch 

Infra-orbital margin 

Maxilla 

Mandible 




External occipital 

protuberance 

Anterior view 

Lateral view 

Parietal bone 



Temporal bone 



Inferior nuchal line 

Spinous process of CII 



Spinous process of TI 

476 

Posterior view


Parietal bone 

Parietal bone 

Frontal bone 

Frontal suture (metopic) 

Temporal bone 

Occipital 

bone 

Ethmoid bone 


Nasal bone 

Inferior nasal concha 

Temporal bone 

Vomer 

Maxilla 

Sphenoid bone 


Parietal bone 

Ethmoid bone 

Frontal bone 

Palatine bone 

Lacrimal bone 

Mandible 

Bones of the skull 

Sphenoid bone 

Temporal bone 

Lacrimal bone 

Nasal bone 


Vomer 

Maxilla 

Mandible 

477

HEAD AND NECK • Skull: anterior view 

Frontal bone 

Frontal suture (metopic) 

Glabella 

Superciliary arch 

Nasion 

Supra-orbital notch (foramen) 

Zygomatic process (of frontal bone) 

Superior orbital fissure 

Nasal bone 

Piriform aperture 

Inferior orbital fissure 

Frontal process (of maxilla) 


Infra-orbital foramen 

Nasal crest 

Maxilla 

Ramus of 

mandible 

Zygomatic process (of maxilla) 

Anterior nasal spine 

Alveolar process 


Alveolar part of mandible 

Frontal bone 

Oblique line 

Mandible 

Parietal bone 

Body of mandible 

Mental protuberance 

Anterior view of the skull 

Mental foramen 

Temporal bone 

Mental tubercle Nasal bone 

Lacrimal bone 

Sphenoid bone 


Vomer 

Maxilla 

478


Lesser wing of sphenoid 

Frontal sinus 

Ethmoid air cells 

Maxillary sinus 


Anterior view of the skull. 


Coronal suture 

Supra-orbital notch (foramen) 





Anterior view of the skull. 


479

HEAD AND NECK • Skull: lateral view 

Sphenoparietal suture 

Sphenosquamous suture 


Squamous part (of temporal bone) 

Frontal bone 

Squamous suture 

Parietal bone 

Pterion 

Greater wing 

(of sphenoid bone) 

Supra-orbital 

foramen 

Lacrimal bone 

Nasal bone 

Zygomaticofacial 

foramen 

Infra-orbital 

foramen 


Lambdoid suture 

Parietomastoid 

suture 


Asterion 

Occipitomastoid suture 

Maxilla bone 


Tympanic part (of temporal bone) 

Mastoid part (of temporal bone) 


Alveolar part 

(of mandible) 


Condylar process 

Ramus (of mandible) 

Angle (of mandible) 

Sphenoid bone 

Parietal bone 

Zygomatic process 

(of temporal bone) 


Coronoid process (of mandible) 

Temporal process (of zygomatic bone) 

Lateral view of the skull 

Frontal bone 

Ethmoid bone 

Lacrimal bone 

Nasal bone 


Maxilla 


Temporal bone 

480



Floor of anterior cranial fossa 

Frontal sinus 

Pituitary fossa 

Posterior clinoid process 


External acoustic meatus 

Hard palate 




Lateral view of the skull. 



Squamous suture 







Lateral view of the skull. 

Volume-rendered lateral view using multidetector computed tomography 

481

HEAD AND NECK • Skull: posterior view 

Sagittal suture 

Parietal foramen (inconsistent and variable in position) 

- for emissary vein 

Parietal bone 

Parietal bone 

Sutural bone 

Sutural bone (inconsistent 

and variable in number and 

position) 

Lambdoid 

suture 

Squamous part of 

occipital bone 


External occipital 

protuberance 

Occipitomastoid suture 

Mastoid notch 

Inion 



External occipital crest 

Parietal bone 

Posterior view of the skull 

Temporal bone 


Maxilla 

482


Nasal bone 


Frontal bone 


Bregma 

Parietal bone 


Frontal bone 

Parietal foramen 

Parietal bone 


Lambda 


Superior view of the skull 


Frontal crest 

Frontal bone 

Groove for superior sagittal sinus 


Parietal bone 

Granular foveolae 

Grooves for 

branches of middle 

meningeal artery 

Frontal bone 



Groove for superior 

sagittal sinus 

Parietal bone 



Roof of the cranial cavity 


483

HEAD AND NECK • Skull: inferior view 

Pterygoid fossa 

Greater wing 

(of sphenoid bone) 

Posterior nasal aperture (choana) 

Pyramidal process 

of palatine bone 

Hamulus 

Posterior nasal spine 

Alveolar arch 

Incisive fossa 

Hard palate (palatine process of maxilla) 

Hard palate (horizontal plate of palatine bone) 

Greater palatine foramen 

Lesser palatine foramen 

Vomer 

Medial plate of pterygoid process 

Body of sphenoid 

Lateral plate of pterygoid process 

Opening of 

pterygoid canal 

Articular tubercle 

Scaphoid fossa 

Foramen lacerum 

Mandibular fossa 

Foramen ovale 

Groove for 

auditory tube 


Foramen spinosum 

Basilar part of occipital bone 

Carotid canal 

Pharyngeal tubercle 

Stylomastoid foramen 

Foramen magnum 


External occipital crest 

Palatine process of maxilla 

Horizontal plate of 

palatine bone 

Mastoid notch 

Jugular foramen 

Zygomatic 

bone 

Hypoglossal canal 

Occipital condyle 


Vomer 

Sphenoid bone 



Temporal bone 

Inferior view of skull 


484


Frontal crest 

Crista galli 

Orbital part (of frontal bone) 

Cribriform plate 

Middle clinoid process 

Anterior clinoid process 

Foramen caecum 

Foramina of cribriform plate 

Chiasmatic sulcus 

Tuberculum sellae 

Optic canal 

Lesser wing (of sphenoid) 

Greater wing (of sphenoid) 


Foramen rotundum 

Hypophyseal fossa 

Dorsum sellae 

Opening of carotid canal 

Trigeminal impression 



Groove and hiatus 

for lesser 

petrosal nerve 

Groove and hiatus 

for greater 


Groove for inferior 

petrosal sinus 


Foramen ovale 

Arcuate eminence 

Tegmen tympani 

Internal acoustic 

meatus 

Groove for 

sigmoid sinus 



Jugular tubercle 

Clivus 


Internal occipital crest 

Groove for transverse sinus 

Internal occipital protuberance 

Anterior cranial fossa 

Frontal bone 

Ethmoid bone 

Middle cranial fossa 

Sphenoid bone 

Temporal bone 

Parietal bone 

Posterior cranial fossa 


Floor of the cranial cavity 

485

HEAD AND NECK • Ethmoid, lacrimal bone, inferior concha, and vomer 

Crista galli 

Perpendicular plate 

Alar process 

Crista galli 

Slit for process 

of dura mater 

Ala of crista galli 

Anterior ethmoidal 

groove 

Ethmoidal cells 


Posterior ethmoidal 

groove 


Middle concha 

Ethmoid bone (superior view) 

Ethmoid bone (posterior view) 

Ala of crista galli 

Crista galli 

Articulates with lacrimal bone 

Articulates with ethmoid bone 

Anterior 

ethmoidal 

air cells 

Articulates with maxilla 

Orbital plate 

Articulates with palatine bone 

Middle concha 

A 

Lacrimal process 

Ethmoidal process 


Articulates with palatine bone 

Articulates 

with maxilla 



Ethmoid bone (lateral view) 

Articulates with frontal bone 

Lacrimal groove (for lacrimal sac) 

Orbital surface 

B 

MaxilIary process 

Right inferior concha 

A. Medial view B. Lateral view 


Articulates 

with ethmoid 

bone 

Posterior 

lacrimal crest 

Articulates 

with 

maxilla 

Nasal surface 

Articulates with 

septal cartilage 


Articlates with 

sphenoid bone 

A 

Lacrimal 

hamulus 

B 

Alae 

Descending process 

for inferior nasal 

concha 

Right lacrimal bone 

A. Lateral view B. Medial view 

Articulates with maxillae and palatine bones 

Vomer (lateral view) 

486



Nasolacrimal groove 

Perpendicular 

plate 

Conchal crest 


Orbital process 

Frontal process 


Sphenopalatine notch 

Nasal notch 


Canine eminence 



Infra-orbital groove 


Zygomatic process, 

articulates with 

zygomatic bone 

Openings of 

alveolar canals 

Maxillary 

process 

Greater palatine 

groove 

Sphenoidal process 


Horizontal plate 

Muscular uvulae on 

posterior nasal spine 

Tuberosity 


Left palatine bone 


Left maxilla bone (lateral view) 









Ethmoidal crest 

Maxillary hiatus 


perpendicular plate of 

palatine bone 


canal 

Nasolacrimal groove 

Ethmoidal crest 

Middle meatus 

Conchal crest 

Inferior meatus 

Completes wall of 

sphenoidal sinus 

Sphenopalatine 

notch 


Sphenoidal 

process 


Conchal crest 

Conchal crest 

Maxillary process 

Anterior 

nasal spine 




(medial view) 


perpendicular plate of 

palatine bone 

Palatine process 


lateral pterygoid plate 


medial pterygoid plate 





Left maxilla bone (medial view) 

487

HEAD AND NECK • Skull: muscle attachments 

Medial rectus 

Procerus 

Superior oblique 

Levator palpebrae superioris 

Superior rectus 

Lateral rectus 

Corrugator supercilii 

Upper orbital part 

Palpebral part 

Lacrimal part 

Lower orbital part 

Temporalis 


Inferior rectus 

Inferior oblique 

Levator anguli oris 

Nasalis: transverse part 

Nasalis: alar part 

Depressor septi 

Levator labii superioris alaeque nasi 

Levator labii superioris 

Zygomaticus major 

Zygomaticus minor 

Masseter 


Stylopharyngeus 

Styloglossus 

Temporalis 

Masseter 

Buccinator 

Depressor anguli oris 

Platysma 

Origins 

Insertions 

Mentalis Depressor labii inferioris 

Anterior view 

Temporalis 

Lateral pterygoid 

Masseter 


Posterior auricular 


Occipitalis 



Procerus 


Levator labii superioris alaeque nasi 



Nasalis transversus 

Nasalis alaris 

488 


Buccinator 

Mentalis 

Depressor labii inferioris 


Masseter 

Temporalis 

Platysma 

Lateral view 


Stylohyoid 

Styloglossus 


Rectus capitis anterior 


Trapezius 





Rectus capitis posterior major


Medial pterygoid 


Temporalis 

Superior pharyngeal constrictor 



Genioglossus 

Geniohyoid 

Mylohyoid 

Medial view 

Musculus uvulae 

Tensor veli palatini (palatine aponeurosis) 

Masseter 





Tensor veli palatini 

Tensor tympani 

Levator veli palatini 

Temporalis 

Rectus capitis lateralis 




Longus capitis 


Styloglossus 

Stylohyoid 


Digastric; posterior belly 



Occipitalis 



Trapezius 

Inferior view 

489

HEAD AND NECK • Scalp and meninges 

Intracranial venous structure 

(superior sagittal sinus) 

Emissary vein 

Venous lacuna 


Diploic vein 

Arachnoid 

granulations 

S Skin 

C Connective tissue (dense) 

A Aponeurotic layer 

L Loose connective tissue 

P Pericranium 

Meningeal artery 

Skull 

Subdural space 

(potential space 



Pia mater 

Cerebral cortex 

Cerebral artery 

Cerebral vein 

Dural partition (falx cerebri) 

Endosteal layer 

Meningeal layer 

Cranial dura mater 

Inner meningeal layer 

of dura mater 

Outer endosteal 

layer of dura mater 

Periosteum 

(pericarnium) 

Spinal dura mater 


Arachnoid 

Skull 

Scalp and cranial meninges 

Vertebra CI 

Spinal 

extradural 

space 

Skull 

Cranial 

dura 

mater 

External table 

Diploe 

Internal table 

Endosteal layer 

Meningeal layer 



Pia mater 


Cerebral cortex 

Diploic vein 

Subdural space (potential space) 

Extradural space (potential space) 

Periosteum 

Continuity of cranial meninges with spinal meninges 

Arrangement of the 

meninges and spaces 

490


Falx cerebri 

Tentorium cerebelli 

Falx cerebelli 


Dural partitions (sagittal section) 

Falx cerebri (cut) 

Perforations in dura leading to foramina 

of cribriform plate 

Pituitary gland 


Attached part of tentorium 

Free edge of tentorium 


Optic canal 

Position of foramen rotundum 

Position of foramen lacerum 

Position of foramen ovale 

Position of foramen spinosum 

Position of jugular foramen 

Position of hypoglossal canal 


Falx cerebri (cut) 

Cranial cavity (superior view) 

491

HEAD AND NECK • Dural arteries and nerves 

Position of pterion 

Recurrent meningeal from 

ophthalmic artery 

Posterior meningeal artery (from 

ascending pharyngeal artery) 

Middle meningeal artery 

Meningeal branch (from 

ascending pharyngeal artery) 

Anterior meningeal arteries 

(from ethmoidal arteries) 


Meningeal artery (from occipital 

artery) 

Maxillary artery 

Meningeal artery (from vertebral artery) 

Ascending pharyngeal artery 


External carotid artery 

Dural arterial supply (medial view) 

Anterior meningeal branches 

of anterior ethmoidal nerve 

Anterior ethmoidal nerve (V 1 ) 

Meningeal branch of maxillary nerve (V 2 ) 

Meningeal branch of mandibular nerve 

(nervus spinosum) (V 3 ) 


Diaphragma sellae 

Recurrent meningeal branch of 

ophthalmic nerve (tentorial nerves) (V 1 ) 

C2, C3 fibers 

C2, C3 fibers accompanying CNXII 


C2 fibers accompanying CNX 


492 

Dural innervation (superior view)


Cerebral veins 

Falx cerebri 

Superior sagittal sinus 


Inferior sagittal sinus 


Superior petrosal sinus 

Sphenoparietal sinus 


intercavernous sinuses 

Basilar venous plexus 

Great cerebral vein 

Straight sinus 

Confluence of sinuses 

Falx cerebelli 

Occipital sinus 

Transverse sinus 

Sigmoid sinus 

Inferior petrosal sinus 

Dural venous sinus (medial view) 


Falx cerebri 

Superior ophthalmic vein 


intercavernous sinuses 

Cavernous sinus 

Basilar venous plexus 



Sphenoparietal sinus 




Sigmoid sinus 


Great cerebral vein 

Straight sinus 



Superior view 


493

HEAD AND NECK • Brain 

Precentral gyrus 

Precentral sulcus 

Central sulcus 

Postcentral gyrus Frontal lobe 

Postcentral sulcus 

Parietal lobe 

Superior frontal gyrus 

Middle frontal gyrus 

Temporal lobe 

Occipital lobe 

Intraparietal sulcus 

Angular gyrus 

Supramarginal 

gyrus 

Inferior frontal 

gyrus: 

Pars opercularis 

Pars triangularis 

Pars orbitalis 

Central sulcus of insula 

Frontal operculum 

Lateral sulcus 

Temporal gyri 

Parietal operculum 

Superior temporal sulcus 

Pre-occipital notch 

Cerebellum 

(metencephalon) 

Pons (metencephalon) 

Circular sulcus of insula 

Medulla oblongata 

(myelencephalon) 

Orbital sulci 

Longitudinal 

cerebral fissure 

Lateral view of the brain 

Frontal pole 

Olfactory bulb 

Short gyri 

of insula 

Long gyri of insula 

Temporal operculum 

Insula exposed by retracting opercula 

Cerebral hemispheres (telencephalon) 

Temporal pole 

Uncus 

Olfactory tract 

Orbital gyri 

Optic nerve (cut) 

Inferior temporal gyrus 


Frontal lobe 

Mammillary body 

Parahippocampal 

gyrus 

Occipitotemporal gyri 

Midbrain 

Collateral sulcus 

Parietal lobe 

Calcarine sulcus 

Isthmus of cingulate gyrus 

494 

Superior view 


Lingual gyrus 

Inferior view (brainstem removed) 

Occipital pole

Brain 8 

Corpus callosum (body) 

Superior frontal gyrus 

Cingulate gyrus 

Fornix 

Paracentral lobule 

Central sulcus 

Marginal sulcus 

Interthalamic adhesion 

Thalamus 

Cingulate sulcus 

Precuneus 

Parieto-occipital sulcus 

Septum pellucidum 

Corpus callosum 

(genu) 


(rostrum) 

Choroid plexus 

Posterior 

commissure 

Corpus 

callosum 

(splenium) 

Cuneus 

Anterior commissure 

Calcarine 

sulcus 

Frontal lobe 

Diencephalon 

Parietal lobe 

Optic 

chiasm 


Lingual gyrus 

Pineal gland 

Superior 

colliculus 

Inferior colliculus 

Hypothalamus 


Uncus 

Hypothalamic sulcus 

Pons 

Cerebellum 

Superior medullary vellum 

Fourth ventricle 

Temporal lobe 


Sagittal section of the brain 

Inferior medullary vellum 

Brainstem 

Corpus callosum (trunk) 

Fornix 

Corpus callosum (genu) 

Thalamus 


(splenium) 

Parieto-occipital 

sulcus 

Pineal gland 



Hypothalamus 

Optic chiasm 

Superior colliculus 



Pons 

Fourth ventricle 

Cerebellar tonsil 


Spinal cord 

Sagittal view of the brain with major structures indicated. 


495

HEAD AND NECK • Brain: imaging 

Frontal lobe 

Caudate nucleus (head) 

Lateral ventricle (frontal horn) 

Anterior limb of internal capsule 

Genu of internal capsule 

Putamen 

Globus pallidus 

Corpus callosum (splenium) 

Posterior limb of internal capsule 

Thalamus 

Lateral ventricle (atrium) 


A 

Lens 

Temporal lobe 

Middle cerebral artery 

Optic nerve 

Optic chiasm 

Optic tract 


Cerebellum 

Cerebral peduncle 

Midbrain 

Cerebral aqueduct 


B 

Axial or horizontal sections through the brain with major structures indicated. 

A. Section showing structures related to the internal capsule. 

B. Section showing structures related to the midbrain. 


496



Frontal lobe 


Lateral ventricle (anterior horn) 

Caudate nucleus (head) 

Putamen 

Internal capsule (anterior limb) 

Anterior cerebral artery 


Optic chiasm 

Internal carotid artery 

Temporal lobe 

A 



Lateral ventricle (body) 

Internal capsule 

Putamen 

Globus pallidus 

Thalamus 

Caudate nucleus (body) 

Fornix 

Lateral sulcus (sylvian fissure) 

Insula 

Third ventricle 

Temporal lobe 

Hypothalamus 

Pons 

B 

Coronal sections through the brain with major structures indicated. 

A. Section showing structures related to the optic chiasm. 

B. Section showing structures related to the third ventricle. 


497

HEAD AND NECK • Cranial nerves 


Olfactory nerves [I] 

Optic nerve [II] 

Oculomotor nerve [III] 

Ophthalmic nerve [V 1 ] 

Maxillary nerve [V 2 ] 

Mandibular nerve [V 3 ] 

Abducent nerve [VI] 

Trochlear nerve [IV] 

Trigeminal ganglion 

Motor root of V 

Motor root 



Spinal cord 

Sensory root 

(intermediate nerve) 

Vestibulocochlear 

nerve [VIII] 

Glossopharyngeal 

nerve [IX] 

Vagus nerve [X] 

VII 

Hypoglossal nerve [XII] 



(cut edge) 

Optic chiasm 

Diaphragma sellae 




Ophthalmic division of 

trigeminal nerve [V 1 ] 

Maxillary division of 

trigeminal nerve [V 2 ] 



Cavernous (venous) sinus 

Dura mater 

Sphenoidal sinus 

Nasopharynx 

498



Olfactory tract 



Optic chiasm 

Infundibulum 

(stalk of pituitary gland) 



Midbrain 

Pons 

Motor root 

VII 

Sensory root 


Vestibulocochlear nerve [VIII] 


Olive 

Pyramid 

Decussation of pyramids 

Cerebellum 






sensory root 


motor root 


Glossopharyngeal nerve [IX] 


Cranial root of accessory 


C1 nerve 

Cranial nerves on the base of the brain 


Pineal gland 

Thalamus 

Superior and inferior colliculus 

Posterior cerebral artery 

Superior cerebellar artery 

Median sulcus of fourth ventricle 

Cerebellar 

peduncles 

Transverse dural 

venous sinus 


nerve [IX] 


with cranial root 

of accessory 


Atlanto-occipital joint 

C1 




Motor root of 

facial nerve [VII] 

Sensory root of 




nerve [VIII] 



cerebellar artery 


Transverse process of atlas 



C2 


Dura mater 

Spinal ganglion of C2 

Cranial nerves (posterior view) 

499

HEAD AND NECK • Arterial supply to brain 


Anterior communicating artery 




Posterior communicating artery 

Ophthalmic artery 


Basilar artery 




Posterior 

communicating artery 


Cavernous 

sinus 



Vertebral arteries 

Atlas (CI) 



Left internal 


Left external 


Facial artery 


Lingual artery 

Superior thyroid artery 

External carotid 

Carotid sinus 

Internal carotid 


Transverse process of CVI 

Left vertebral 

Right vertebral artery 

Left vertebral artery 

Left common carotid 

Left subclavian 




Left common 


Aortic arch 

Arteries to brain (lateral view) 

Diagram showing blood supply to brain 


Anteromedial arteries 


Medial striate artery 

Optic chiasm 

Hypophyseal arteries 



Posterior communicating artery 

Posterolateral (perforating) arteries 


Pons 

Pontine arteries 


Labyrinthine artery 

Anterior inferior cerebellar artery 



Anterolateral central arteries (lateral striate) 

Anterior choroidal artery 

Posteromedial (perforating) arteries 


Choroid plexus of lateral ventricle 

Posterior lateral choroidal artery 

Lateral ventricle 

500 

Cerebral arterial circle (of Willis)










Left internal carotid atery 

Left external carotid atery 




Facial artery 





Right common carotid 

Left inferior thyroid artery 




Anterior view of the carotid and vertebral arterial systems. 









Posterior view of the cerebral arterial circle (of Willis). 

Volume-rendered posterior view using multidetector computed tomography 

501

HEAD AND NECK • Arterial supply to brain 

Frontal lobe 


Anterior 

communicating artery 


Middle 

cerebral artery 

Lateral frontobasal 

(orbitofrontal) artery 

Posterior 

communicating 

artery 

Posterior 


Superior 




Insula 

Temporal lobe (cut) 

Posterior cerebral 

artery 

Cerebellum 






Arteries of the brain (inferior view) 

Central artery 

Precentral artery 

Postcentral artery 

Callosomarginal artery 

Pericallosal artery 

Prefrontal 

artery 

Angular artery 

Parieto-occipital 

artery 

Polar frontal 

artery 

Middle 


Anterior temporal artery 

Posterior temporal artery 

Middle temporal artery 

Orbitofrontal 

artery 

Anterior 



Temporal branches 

Calcarine artery 

502 

Lateral view 

Blood supply to the cerebral hemispheres. 

Anterior cerebral artery (pink), middle cerebral artery (blue), posterior cerebral artery (green) 

Medial view



Zygomaticotemporal 

nerve 

Supra-orbital nerve 

Supratrochlear nerve 

Lacrimal nerve 

Infratrochlear nerve 





External nasal nerve 

Infra-orbital nerve 

Buccal nerve 

Auriculotemporal nerve 


Superior view 

Zygomaticofacial nerve 

Mental nerve 

Trigeminal nerve [V] leaving the skull 

Ophthalmic 

nerve [V 1 ] 

Maxillary 

nerve [V 2 ] 

Zygomaticotemporal nerves 





External nasal nerve 


Mandibular 

nerve [V 3 ] 


Buccal nerve 

Mental nerve 


Cutaneous distribution of the trigeminal nerve [V] 

503

HEAD AND NECK • Facial muscles 

Epicranial aponeurosis 

Frontal belly of 

occipitofrontalis 


occipitofrontalis (cut) 

Procerus 


Temporalis 


Orbital 

Palpebral 

Tendon of levator 

palpebrae superioris 

Medial palpebral ligament 

Orbital septum 


alaeque nasi (cut) 

Levator labii 

superioris 

alaeque nasi 

Zygomaticus minor (cut) 

Zygomaticus major (cut) 

Levator labii 

superioris 



Levator labii superioris (cut) 

Nasalis 


Parotid gland 

Parotid duct 

Masseter 

Risorius 


Buccinator 


Platysma 


Procerus 

Platysma (cut) 


Nasalis (transverse part) 

Mentalis 

Depressor labii inferioris (cut) 

Depressor anguli oris (cut) 

Anterior view 

Occipital belly of 



Nasalis (alar part) 


Trapezius 

504 

Nasal group of facial muscles 

Posterior view



Temporal fascia 

Anterior auricular 

Superior auricular 



Procerus 


Nasalis 

Levator labii 

superioris 

alaeque nasi 

Occipital belly of 



Levator labii 

superioris 





Parotid 

gland 

Levator labii superioris alaeque nasi (cut) 

Levator labii superioris (cut) 

Zygomaticus minor (cut) 

Zygomaticus major (cut) 

Mentalis 


Nasalis 

Risorius 

Buccinator 

Lateral view 

Masseter 

Platysma 

Levator anguli oris (cut) 


Parotid duct (cut) 

Buccinator 

Mentalis 

Pterygomandibular raphe 


Buccinator muscle 

505

HEAD AND NECK • Vasculature, facial nerve [VII], and lymphatics 

Transverse facial artery and vein 

Zygomaticofacial artery and vein 

Superficial temporal artery and vein 

Pre-auricular and parotid nodes 



Occipital artery and vein 

Supra-orbital 


Supratrochlear 


Angular artery 

and vein 

Lateral nasal 


Occipital nodes 

Facial nodes 

Superior labial 


Parotid duct 

Buccinator 

Inferior labial 


Facial vein 

Platysma (cut) 

Facial artery 

Submental nodes 


Mastoid nodes 

Posterior auricular vein 

Posterior auricular artery 


Facial nerve [VII] 

Retromandibular vein 

Jugulodigastric node 

Parotid gland 


External jugular vein 


Internal jugular vein 

Common carotid artery 

Jugulo-omohyoid node 

Vasculature, facial nerve [VII], and lymphatics of the face 

506


Infra-orbital artery Maxillary artery Transverse Superficial 

Ophthalmic 

facial artery temporal artery 

veins 

Cavernous 

sinus 

Transverse 

facial vein 

Superficial 

temporal vein 

Mental artery 

Maxillary 

Deep facial vein 

vein 



Inferior alveolar artery 

Pterygoid plexus of veins 

Facial artery 

Buccal artery 

Deep vasculature of parotid region 

Mandible Medial pterygoid 

Temporofacial branch Masseter 



Parotid gland 

Transverse facial artery and vein 

Temporal branches 

Middle meningeal 

artery 


artery 

Infra-orbital vein 




Main trunk of 


Occipital 

vein 

Internal 

jugular 

vein 

Zygomatic branches 

Posterior 

auricular nerve 


Ramus of mandible 

Masseter 

Parotid duct 

Buccal 

branches 


Cervicofacial branch 

Marginal 

mandibular 

branches 


Cervical branches 

Parotid gland and facial nerve [VII] 



Right external carotid artery 

Dens Atlas 

Right internal carotid artery 


Axial section through the parotid gland showing its 

relationship to surrounding structures. 


507

HEAD AND NECK • Bony orbit 

Superior (upper) eyelid 

Medial commissure 

Frontal bone 

Pupil 

Orbital rim 

Lateral 

commissure 

Greater wing 

of sphenoid 

Sclera 

Iris 

Zygomatic 

bone 

Inferior orbital 

fissure 

Inferior 

(lower) eyelid 

Maxilla 

Lacrimal lake 



Supra-orbital notch 


Optic canal 

Frontal bone 

Posterior ethmoidal foramen 

Anterior ethmoidal foramen 


Greater wing of sphenoid 



Infra-orbital groove 

Ethmoid bone 

Lacrimal bone 

Palatine bone 

Fossa for lacrimal sac 

Maxilla 

Lateral 

Medial 

Bones of the right orbit 

508


Tendon of levator palpebrae superioris 

Periosteum 


Periorbita 

Tendon of superior oblique 




Superior tarsal muscle 

(smooth muscle) 

Optic nerve 

Fascial (dural) sheath 

Superior conjunctival fornix 

Superior tarsus 

Conjunctiva 

Tarsal gland 

Openings of tarsal glands 

Eyelash 

Tarsal gland 

Conjunctival sac 

Inferior tarsus 





Sagittal section through orbit and eyeball 


Cornea 

Lens 

Iris 


Periosteum 

Lacrimal sac 

Medial check ligament 

Fascial sheath 

Medial rectus 

Lateral check ligament 

Retina 

Choroid 

Sclera 

Periorbita 


Optic nerve 

Horizontal (axial) section through orbit and eyeball 

509

HEAD AND NECK • Eyelids and lacrimal apparatus 

Infratrochlear artery, vein, and nerve 

Supratrochlear artery, vein, and nerve 

Supra-orbital artery, vein, and nerve 


Lacrimal sac 

Excretory ducts of lacrimal gland 

Orbital part of lacrimal gland 





Lacrimal artery 

Lateral palpebral 

ligament 

Superficial temporal 




Transverse facial artery 

Palpebral part of 

lacrimal gland 

Lacrimal canaliculi 

Nasolacrimal duct 

Middle nasal 

concha 


nasolacrimal duct 

Inferior nasal meatus 


Infra-orbital artery and nerve 

Angular artery and vein 

Vasculature and nerves of the eyelids 

Nasal cavity 

Lacrimal apparatus 

Periosteum 

Medial 

Medial 

Anterior lacrimal crest 


Lateral 

Lacrimal sac 

Lateral 

Lacrimal caruncle 

Lacrimal fold 

Palpebral fissure 

Lacrimal part of orbicularis oculi 


Posterior lacrimal crest 

Lacrimal sac (horizontal section) 

Lacrimal vessels 

and nerve 

Orbital part of 



Lacrimal papilla 

Lacrimal punctum 



Palpebral part of 


Excretor duct of 


Lacrimal papilla and punctum of left eye 

510 

Lacrimal gland and levator palpebrae superioris (parasagittal section)



Lacrimal 

gland 




nerve 

Ophthalmic nerve [V1] 

Maxillary nerve [V2] 


Mandibular nerve [V3] 


Zygomatic nerve 



ganglion 

Nerve of 


Greater petrosal nerve 

Internal carotid plexus 

(sympathetic) 



Deep petrosal nerve 


artery 

Visceral efferent (motor) innervation of the lacrimal gland 

Postganglion sympathetic 

Medial rectus 



Eyeball 

Eyeball 


Oral cavity 

Tongue 

Coronal section through the orbit showing the lacrimal gland 

and its relationship to surrounding structures. 


511

HEAD AND NECK • Muscles of the eyeball 


Medial rectus 



Eyeball 


Trochlea 

Fossa for lacrimal sac 

Superior oblique (cut) 

Levator palpebrae superioris (cut) 

Superior rectus (cut) 

Medial rectus 


Frontal bone 


Lesser wing 


Tendinous ring 

Optic nerve 

Greater wing 


Levator palpebrae 

superioris 


Superior view 



(cut) 


(cut) 


superioris (cut) 

Tendinous 

ring 


Medial rectus 



Tendon of superior oblique 

Trochlea 

Medial rectus 








Lateral view 



Optic canal 

Conjunctiva 

(overlying sclera) 








Medial rectus 

Ethmoid bone 

Palatine bone 

Lacrimal bone 



Anterior view 


Medial palpebral 

ligament 

512 

Origins of muscles of the eyeball


Lacrimal nerve (from [V 1 ]) 




Medial rectus 


Frontal nerve 

(from [V 1 ]) 



Ophthalmic 

nerve [V 1 ] 




III 


Anterior ethmoidal nerve 

Posterior ethmoidal nerve 

Long ciliary nerves 


Short ciliary nerves 



Inferior branch of 

oculomotor 

nerve [III] 

Nasociliary nerve 

(from [V 2 ]) 

Superior branch 

of oculomotor 

nerve [III] 

IV 

VI 

V 

Lacrimal nerve (from [V 1 ]) 



Frontal nerve 

(from [V 1 ]) 

Nasociliary nerve (from [V 1 ]) 


Superior view 

Trochlear nerve [IV] Frontal branch of ophthalmic nerve [V 1 ] 

Lacrimal branch of ophthalmic nerve [V 1 ] 


Recurrent meningeal artery 

Ophthalmic artery 

(from ophthalmic artery in the orbit) 



superioris 


Medial rectus 

Superior branch of 

oculomotor nerve [III] 


Nasociliary branch of 

ophthalmic nerve [V 1 ] 


Ciliary 

ganglion 



Inferior branch of oculomotor nerve [III] 

Lateral view 

Common tendinous ring 

Inferior branch of 


Inferior ophthalmic vein 

Anterior view 

513






Dorsal nasal artery 

Supratrochlear artery 

Anterior ethmoidal artery 

Dorsal nasal artery 

Supratrochlear artery 

Supra-orbital artery 

Posterior ethmoidal artery 




Short posterior ciliary artery 

Long posterior 

ciliary artery 

Short posterior 


Long posterior 



Central retinal artery 

Recurrent 

meningeal artery 

Optic nerve 

Internal carotid artery Ophthalmic artery 

Arteries of the orbit and eyeball (superior view) 




Supratrochlear vein 

Supra-orbital vein 

Vorticose veins 

Nasofrontal vein 

Angular vein 





Facial vein 




Infra-orbital vein 

Veins of the orbit and eyeball (lateral view) 

515

HEAD AND NECK • Eyeball 

Lens 

Capsule of lens 

Cornea 

Ciliary body 

Sphincter pupillae 

Dilator pupillae 

Scleral venous sinus 

Ciliary process 

Ciliary muscle 

Anterior chamber 

Iris 

Posterior chamber 

Iridocorneal angle 

Conjunctiva 


medial rectus 

Zonular fibers 

Ora serrata 

Anterior ciliary 

artery 

Hyaloid canal 

Optic disc 

Retina 

Choroid 

Sclera 

Episcleral space 

Fascial sheath of eyeball 

Postremal (vitreous) chamber 

Long posterior ciliary artery 

Fovea centralis 

Short posterior 

ciliary arteries 

Optic nerve 

Central artery and vein 

Eyeball (horizontal section) 

516

Eye imaging 8 

Superior nasal retinal arteriole and venule 

Superior temporal retinal arteriole and venule 

Superior and inferior macular arteriole and venule 

Central retinal 

artery 

Nasal 

Temporal 

Optic disc 

Central retinal 

vein 

Macula lutea with 

fovea centralis 

Inferior nasal retinal arteriole and venule 

Inferior temporal retinal arteriole and venule 

Ophthalmoscopic view of the left retina showing the optic disc, 

the macula lutea, and the retinal vasculature 

Short ciliary nerves 



Nasociliary nerve 




Nasociliary root of ciliary 

ganglion (sensory) 

Ciliary 

ganglion 




Oculomotor root of ciliary 

ganglion (preganglionic 

parasympathetic) 


Internal carotid plexus 

(sympathetic) 


artery 

Visceral efferent (motor) innervation of eyeball (iris and ciliary body) 

517

HEAD AND NECK • Eye imaging 





Optic nerve 



Optic nerve 


Medial rectus 


Medial rectus 



Nasal cavity 

A 





Optic nerve 



Optic nerve 


Medial rectus 


Medial rectus 



Nasal cavity 

B 

A through D – Coronal sections that pass through the orbit from posterior to anterior showing the 

extrinsic (extra-ocular) muscles and their relationships with each other and with other structures. 


518

Eye imaging 8 






Eyeball 



Medial rectus 

Eyeball 


Medial rectus 



C 

Medial rectus 

Medial rectus 





D 

519

HEAD AND NECK • Ear surface and sensory innervation 


Crura of antihelix 

Tragus 

Lesser occipital nerve (C2) 

Auriculotemporal branch of the 

mandibular nerve [V3] 



Helix 

Concha 

Antihelix Antitragus 

Lobule 

Intertragic notch 

Great auricular nerve (C2,C3) 

External ear (auricle) 

Sensory innervation of the auricle 

Greater petrosal 

nerve [VII] 

Geniculate ganglion 

Foramen ovale 

Groove and hiatus for 

greater petrosal nerve 

Groove and hiatus for 

lesser petrosal nerve 

Cochlea 

Anterior 

semicircular canal 

Lateral 


Vestibular nerve 

Posterior 


Intermediate nerve 

(sensory root of VII) 


Cochlear nerve 


External opening for vestibular aqueduct 

Internal acoustic meatus 

Superior projection of internal ear in the temporal bone 

520

Ear 8 

Auricle 

Epitympanic recess 

Lateral semicircular canal 

Anterior semicircular canal 

Posterior semicircular canal 


Stapes 

Incus 

Oval window 

Internal ear 

Malleus 







nerve [VIII] 

Internal acoustic 

meatus 

Pharyngotympanic tube 

External acoustic meatus Cartilage Tympanic membrane 


Pars flaccida 

Middle ear 

Round window 

Lateral ligament of malleus 

Nasopharynx 

Posterior 

malleolar fold 

Handle of 

malleus 

Lateral process of malleus 

Long limb of incus 

Anterior malleolar fold 

Stapes 

Pyramidal eminence 

Tendon of stapedius 

Round window 


of malleus 

Chorda tympani 

nerve 

Tendon tensor 

tympani 

Handle of malleus 

Umbo 

Cone of light 


tympanic membrane 

Promontory 

Right tympanic membrane 

View into right tympanic cavity (tympanic membrane removed) 

521

HEAD AND NECK • Middle ear 

Footplate of stapes in oval window 

Prominence of lateral semicircular canal 

Nerve to stapedius muscle 

Mastoid cells 

Prominence of facial canal 



Intermediate nerve (sensory root of VII) 



Lesser petrosal nerve 

Tensor tympani muscle 


Posterior 


Round window 

Stapes 

Tendon of Jugular notch 

stapedius muscle 


Tympanic nerve (from 

glossopharyngeal nerve [IX]) 

Promontory 

Tympanic plexus 



Anterior 

Branch from internal carotid 

plexus (caroticotympanic nerve) 

Incus articulation 

Right medial wall of the middle ear 

Head of malleus 

Neck of malleus 

Anterior process 

Short limb 

Malleus articulation 

Malleus 

Incus 



Body of incus 

Long limb 

Lenticular process 

of incus 

Right malleus 


Footplate of stapes 

Right incus 


Stapes 

Posterior limb 

Anterior limb 

Head of stapes 

Right auditory ossicles articulated (medial view) 

522 

Right stapes (superolateral view)

Middle ear 8 

Superior ligament of malleus 

Head of malleus 

Anterior ligament of malleus 

Anterior process of malleus 

Superior ligament of incus 

Short limb of incus 

Posterior ligament of incus 

Long limb of incus 


Anterior malleolar fold 

Tendon of tensor tympani muscle 




Anterior 



Posterior 


Tympanic membrane 

Mastoid antrum 

Aditus to mastoid antrum 


Lenticular process 

of incus 

Right lateral wall of the middle ear 

Tegmen tympani 






of mandible 

Anterior 

External 

acoustic meatus 

Posterior 

Mastoid 

air cells 

Middle ear 

Jugular fossa 

Carotid canal 

Mastoid air cells 



Right mastoid antrum and surrounding bone 

Inferior view of the mastoid area 

on the right side of the skull. 


523

HEAD AND NECK • Internal ear 

Utricle 


Posterior semicircular canal 

Stapes in 

oval window 

Vestibule 


Ampulla 

Anterior semicircular canal 

Vestibular aqueduct 

Dura mater 








nerve [VIII] 

Helicotrema 

Cochlea 

Utriculosaccular 

duct 

Tympanic 

membrane 

Round window 

Saccule 

Structures of the internal ear (right) 

Scala vestibuli 

Scala vestibuli 

Vestibular membrane 

Tectorial membrane 

Cochlear duct 

Scala tympani 

Cochlear duct 

Lamina of modiolus 

Spiral ligament 

Spiral organ 

Nerve fibers 

Modiolus 

Spiral ganglion 

Outer hair cells 

Pillar cells 

Basilar membrane 

Scala tympani 


Inner hair cells 

524 

Cross section through cochlea

Ear imaging 8 

Cochlea 

Malleus 

Cochlea 

Incus 




Malleus 

A 

B 





Basal turn of cochlea 

Promontory 

Middle ear 


Utricle 


Utricle 





A through C – Axial sections that pass 

through the left ear from inferior to 

superior showing various structures 

in the right ear and their relationships 

with surrounding structures. 

CT images in axial plane 

C 

525

HEAD AND NECK • Temporal and infratemporal fossae 

Superior temporal line 

Inferior temporal line 

Temporalis 


of frontal bone 

Frontal process of 



Supramastoid crest 


Masseter 

Temporal fossa 

Infratemporal fossa 

526


Frontal bone 

Sphenoid bone 

Temporal bone 


Maxilla 


Mandible 


Infratemporal crest 

Foramen ovale 

Temporal bone 



Petrotympanic fissure 

Frontal bone 

Groove for middle temporal artery 


Greater wing 

of sphenoid bone 

Tympanomastoid fissure 

Frontal process of 


Pterygopalatine fossa 

Infratemporal surface 

of maxilla 

Zygomatic bone (cut) 

Head and neck of 

mandible (cut) 

Alveolar foramen 

Lateral plate of pterygoid 

process of sphenoid bone 


Palatine bone 

Tympanic plate 

Spine of sphenoid 

Posterior surface of maxilla 



Pterygomaxillary fissure 

(leading into pterygopalatine fossa) 

Pterygoid hamulus 

Ramus of mandible (cut) 

Bones of the temporal and infratemporal fossae 

527

HEAD AND NECK • Temporal and infratemporal fossae 

Cut temporal fascia 

Temporalis 

Superior temporal line 

Inferior temporal line 

Temporalis 


Deep part 

Superficial part 

Masseter 


Temporalis and masseter 

Infratemporal crest Lateral pterygoid 

Temporalis (cut) 

Upper head Lower head 

Masseteric artery 

Masseteric nerve 


Nasal cavity 



Capsule of 

temporomandibular joint 

Temporalis 

Lateral ligament 

Neck of mandible (cut) 

Medial pterygoid (superficial head) 

528 

Buccinator 

Medial pterygoid (deep head) 

Muscles of the infratemporal fossa 

Sphenomandibular 

ligament 

Stylomandibular 

ligament 

Superior 

constrictor 

Masseter (cut) 

Middle 

constrictor 

Mandibular canal 


Masseter 


Lingual nerve 

Mandible 




Parotid gland 

Inferior alveolar nerve 



Nasopharynx 





Horizontal (axial) through infratemporal fossa 

(inferior view)


Foramen ovale 

Muscles of the infratemporal fossa 

Lateral ligament 

Capsule 

Upper head of 

lateral pterygoid (cut) 

Lower head of 








ligament 


Superior constrictor 

Styloglossus 


Deep head medial pterygoid 


Superficial head medial pterygoid 

Attachment of medial pterygoid 

on medial surface of mandible 


Stylomandibular ligament 

Pterygomandibular 

raphe 

Upper joint cavity 



Capsule 


Temporomandibular joint (lateral view) 

Lingula 


Mylohyoid groove 


Stylomandibular 

ligament 

Capsule 


ligament 


Fibrocartilage on articular surface 

Lower joint cavity 

Temporomandibular joint (medial view) 

Sagittal section through temporomandibular joint 

529

HEAD AND NECK • Temporomandibular joint 

A 





B 


Forward movement of disc and 

mandible at upper joint 

Protrusion 

• lateral pterygoid assisted 

by medial pterygoid 

Retraction 

• posterior fibers of temporalis, 

deep part of masseter, 

geniohyoid, and digastric 

Hinge movement 

at lower joint 

Elevation 

• temporalis, masseter, and 

medial pterygoid 

Depression 

• gravity 

• digastric, geniohyoid, and mylohyoid 

Movements of the temporomandibular joint 

A. Mouth closed B. Mouth open 









A 

B 

530 


Hyoid bone 






Lateral view of the right temporomandibular joint 

A. Mouth closed B. Mouth open. 

Image taken with Cone Beam Computerized Tomography (CBCT) 

technology viewed in the radiographic mode 


Angle of mandible


Zygomaticotemporal nerve 

(branch of maxillary nerve [V 2 ]) 

Deep temporal nerves 





Zygomaticofacial 

nerve 

(branch of 

maxillary 

nerve [V 2 ]) 

Mental nerve 

Nerves of the temporal and 

infratemporal fossa 






Temporal fascia 


fossa 

Temporalis 

Buccal artery 

and nerve 

Auriculotemporal 

nerve 

Lingual nerve 

Buccinator 

Facial vein 

Facial artery 


Nerves and vessels of the 




Superficial 

temporal 

artery 

Middle 

meningeal 

artery 



ligament 


Inferior alveolar 

artery and nerve 

Retromandibular 

vein 








Nerve to lateral pterygoid 


tendon of temporalis 


Lingual nerve 

Buccal nerve 

Incisive nerve 

Chorda tympani nerve 



ligament 

Nerve to mylohyoid 




mandibular nerve [V 3 ] 

Meningeal nerve 


Posterior trunk of 


Mental nerve 

Mylohyoid 

531

HEAD AND NECK • Parasympathetic innervation 






Meningeal nerve 


Branch to tensor tympani 



Petrotympanic fissure 

Branch to tensor veli palatini 

Branch to medial pterygoid 

Tongue 


Chorda tympani branch of [VII] 


Lingual nerve 

Mylohyoid 

Submandibular ganglion 

Submandibular gland 

Nerves of the infratemporal fossa 










Otic ganglion 



Tympanic nerve 

Inferior 

ganglion of IX 

Lingual nerve 




Parotid gland 


Submandibular 

gland 

Parasympathetic innervation of parotid, 

submandibular, and sublingual salivary glands 

532 


Arteries and veins of temporal and infratemporal fossae 8 

Sphenopalatine artery 


Branches of middle meningeal 

artery in cranial cavity 

Deep temporal arteries 

Inferior ophthalmic artery 

Middle temporal artery 









Buccal artery 



Pterygoid artery 


Inferior alveolar artery 

Mylohyoid branch of 

inferior alveolar artery 


External carotid 

Mental artery 

Mylohyloid 

Arteries of the temporal and infratemporal fossae 

Sphenopalatine vein 

Deep temporal vein 


Emissary veins 

(connect with cavernous sinus) 





Pterygoid plexus 


Maxillary vein 



Inferior alveolar vein 



Facial vein 



Mental vein 


Veins of the temporal and infratemporal fossae 

533 


HEAD AND NECK • Pterygopalatine fossa 



Lacrimal bone 

Infra-orbital fissure 

Ethmoid bone 

Optic canal 


Sphenopalatine foramen 

Tuberculum sellae 

Hypophyseal fossa 

Dorsum sellae 

Palatine bone 



sphenoid 

Sphenoid bone 

Maxilla 




Foramen ovale 

Pterygoid canal 

Palatovaginal canal 

Bones of the pterygopalatine fossa 

Palatine canal 


Lesser wing 

Dorsum sellae 

Body 

Sphenoid process 

Greater wing 

Greater wing 

Superior 

orbital fissure 


Pterygopalatine canal 

Lateral pterygoid plate 

Pterygoid process 

Medial pterygoid plate 

Surface related to 

pterygopalatine fossa 



Sphenoid bone (anterior view) 

534 



Orbital nerves 


Sphenopalatine artery 

Nasal nerves 






nerve 


Ganglionic branches 


Meningeal branch 

Maxillary nerve [V 2 ] entering 

foramen rotundum 



alveolar artery and nerve 


Inferior palpebral branch 


and artery 

External nasal branch 

Middle superior 

alveolar nerve 

Superior labial branch 


Posterior superior alveolar nerve and artery 

Superior alveolar plexus 

Nerves and arteries of the pterygopalatine fossa 


Maxillary artery in 


Nerve and artery of 


Pterygopalatine ganglion 

Pharyngeal nerve and artery 

entering palatovaginal canal 

Palatine nerve and artery 

in palatine canal 

Lesser palatine nerve and artery 

Greater palatine nerve and artery 





Lacrimal 

gland 

Ophthalmic nerve [V 1] 




Zygomatic nerve Maxillary 

Orbital branches nerve [V 2] 

Nasal nerves 

Mandibular 

nerve [V 3] 



Internal 

carotid plexus 

(sympathetic) 

Internal 

carotid nerve 





Preganglionic sympathetic Pterygopalatine 


ganglion 

Palatine 

nerves 


pterygoid 

canal 

Cartilage filling 

foramen lacerum 

Pharyngeal nerve 

in palatovaginal canal 


Internal 

carotid 

artery 

Superior 

cervical 

ganglion 

Sympathetic 

trunk 

Visceral efferent (motor) pathways through the pterygopalatine fossa 

535 


HEAD AND NECK • Neck surface anatomy 



Midline of neck 

Anterior margin of 

sternocleidomastoid 

Thyroid notch 

Thyroid prominence 

Position of cricothyroid 

(cricovocal) ligament 

Posterior margin of 

sternocleidomastoid 

Arch of cricoid cartilage 

Isthmus of 

thyroid gland 

Clavicle 

Anterior margin 

of trapezius 

Thyroid notch 


Position of cricothyroid 

(cricovocal) ligament 


Clavicle 

Anterior triangle 

associated with structures coursing 

between head and thorax 

Anterior view 

Posterior triangle 

associated with structures coursing 

between thorax/neck and upper limb 

Lateral view 

Posterior belly of digastric 


Stylohyoid 

Carotid triangle 

Submandibular triangle 


Inferior belly of omohyoid 

Trapezius 

Anterior belly of digastric 

Submental triangle 

Hyoid bone 

Muscular triangle 

Superior belly of omohyoid 

Clavicle 

Boundaries and subdivisions of the anterior triangle 

and boundaries of the posterior triangle 

536 






Greater horn 

Carotid canal 




Body 

Hyoid bone (superior view) 

Lesser horn 

Occipital condyles of skull (inferior view) 



Articular facet for dens 

Dens 

Anterior arch 


Superior 

articular facet 

Lateral mass 

Foramen 

transversarium 

Groove for 

vertebral artery 

Alar ligaments 



Atlas and axis (superior view) 

Tectorial membrane (upper part 

of posterior longitudinal ligament) 

Posterior arch 

Transverse 

process 


Superior longitudinal band 

of cruciform ligament (cut) 

Stylohyoid ligament 

Cut body of hyoid 

Apical ligament of dens 



Lesser horn 

Greater horn 

CIII 

CIV 

CV 

CVI 

CVII 

Atlas CI 


Axis CII 


process 

Interarticular part 

Inferior articular 

process 


Axis 

Atlas 



Inferior longitudinal band 

of cruciform ligament 

Rib I 

TI 

Groove for 

vertebral artery 

Posterior longitudinal 


Spinous process of axis 

Atlanto-occipital joint (posterior view) 

Bones of the neck (lateral view) 

537 


HEAD AND NECK • Compartments and fascia of the neck 


Esophagus 

Infrahyoid muscles 

Trachea 

Pretracheal fascia 


Thyroid gland 

Pretracheal layer 



Esophagus 



Thyroid gland 

Trachea 


Carotid 

sheath 

External jugular 

vein 

Vagus nerve 

Scalene 

muscles 

Trapezius 

Prevertebral fascia 

Investing layer 

Fascia of the neck (transverse view) 



Vertebra CVII 

Trapezius 

Visceral compartment Vascular compartment Vertebral compartment 

Fascia compartments of the neck. 


Buccopharyngeal fascia 

(posterior portion of 

pretracheal layer) 



Prevertebral layer 

Trachea 

Thyroid gland 


Pretracheal space 

Suprasternal space 

Pretracheal layer 

Retropharyngeal space 

Esophagus 


Aorta 

538 

Fascia of the neck (sagittal view) 

Fascial space within 

prevertebral layer


Facial vein 

Anterior jugular veins 




Palpable veins of the neck 

(or visible) 



Facial vein 

Submental vein 



Common facial vein 






Communicating vein 

Trapezius 


Communicating vein 






Superficial veins of the neck 

539

HEAD AND NECK • Muscles of the neck 

Parotid fascia 

Masseteric fascia 

Risorius 


Platysma 

Investing layer of 

deep cervical fascia 

Clavicle 

Pectoralis major fascia 

Deltoid fascia 


Muscles and fascia of the neck (lateral view) 

Anterior triangle 

Masseter 

Middle constrictor 

Stylohyoid 


Mylohyoid 

Fibrous loop for 

digastric tendon 


Hyoid bone 

Inferior constrictor 

Thyrohyoid 

Superior belly of 

omohyoid 

Sternohyoid 







Occipital belly 

of occipitofrontalis 




Clavicular head 


Sternal head 


Clavicle 



Inferior belly of 

omohyoid 

Trapezius 

Acromion 

Deltoid 

540



Mylohyoid 


Sternohyoid 

Superior belly of omohyoid 

Thyroid cartilage 

Cricothyroid (cricovocal) membrane 

Cricoid cartilage 

Thyroid gland (isthmus) 


Trapezius 

Inferior belly of omohyoid 

Trachea 




Stylohyoid 

Hyoid bone 

Thyrohyoid 

Sternohyoid (cut) 



Cricothyroid 


Sternothyroid 



Sternohyoid (cut) 




Clavicular 

head 

Sternal head 

Superficial muscles of the neck 




Atlas 


Contribution to middle scalene from CI 

(sometimes absent) 



Superior part of longus colli 




Vertebral body of CVI 

Longus colli 




Rib I 

Scapula 

Deep muscles of the neck 

Rib II 

541

HEAD AND NECK • Nerves in the neck 



Great auricular nerve (C2,C3) 

Accessory nerve and branches 

of the cervical plexus 


Transverse cervical nerve (C2,C3) 



(medial, intermediate, lateral) (C3,C4) 

Trapezius 



Digastric (cut) 



Stylohyoid 

Facial artery 


C1 spinal nerve 



Mylohyoid 



Hyoglossus 


C1 fibers accompanying the hypoglossal 

nerve to geniohyoid muscle 

Thyrohyoid 


Omohyoid (superior belly) 

Superior root of ansa cervicalis 

Cervical spinal nerves, ansa cervicalis, 

and hypoglossal nerve [XII] 

Sternohyoid 

Sternothyroid 



Inferior root of ansa cervicalis 




Phrenic nerve 

(C3,4,5) 

Omohyoid 

(inferior belly) 

542




Styloglossus 


Buccinator 


Stylohyoid (cut) 


Inferior ganglion of vagus nerve [X] 


Pharyngeal branch 


Hyoglossus 


Thyrohyoid membrane 

Internal branch of superior laryngeal nerve 



External branch of 

superior laryngeal nerve 

Cricothyroid (cricovocal) ligament 


Carotid branch of vagus nerve 


of glossopharyngeal nerve 

Carotid sinus branch 

of glossopharyngeal nerve 


Carotid body branch 


Carotid sinus 

Vagus [X] 



Phrenic nerve (C3, C4, C5) 


Branches of glossopharyngeal [IX] and vagus nerves [X] in neck 

543

HEAD AND NECK • Cervical plexus and sympathetic trunk 

C1 (anterior ramus) 

C2 

(anterior 

ramus) 


Great auricular nerve (C2, C3) 

Ansa cervicalis 

Superior root 

Transverse cervical nerve 

(C2, C3) 


C2 branch to transverse cervical 


Inferior root 

To C5 (anterior ramus) 

Supraclavicular nerves (C3, C4) 

Phrenic nerve (C3, C4, C5) 


Superior ganglion of right vagus nerve X 

Glossopharyngeal nerve IX 

Accessory nerve XI 

Superior cervical ganglion 

Cervical plexus 


Internal carotid nerve 

Hypoglossal nerve 

C2 




C1 


C3 


C4 


Middle cervical ganglion 

Phrenic nerve 

C5 

Longus colli 

Phrenic nerve 


Inferior cervical ganglion 

Posterior 

Middle 

Anterior 

Scalene muscles 





Left brachiocephalic 

vein 

544 

Components of the sympathetic nervous system in the root of the neck


Internal carotid nerve 

Superior cervical ganglion 

C1 

To internal carotid plexus 


Gray rami 

C2 

C3 

To carotid body and sinus 

To external carotid plexus 

C4 

C5 

Superior cardiac nerve 




To geniohyoid muscle 

To thyrohyoid muscle 



C6 

C7 

Middle cervical ganglion 

Inferior cervical ganglion 

Superior ganglion of 

right vagus nerve 


C1 

CI 

C8 

Communication to vagus nerve 


Great auricular nerve 

C2 

CII 

Lesser occipital nerve 

Middle and inferior cardiac nerve 

Communication to accessory nerve 


C3 

CIII 


Inferior root of ansa cervicalis 

C4 

CIV 

Ansa subclavia 

Cervical part of the sympathetic trunk 

To scalene and levator scapulae muscles 

C5 

CV 


C6 

CVI 

Superior trunk of brachial plexus 

Phrenic nerve 

C7 

CVII 

Middle trunk of brachial plexus 

C8 


Inferior trunk of brachial plexus 

T1 

TI 


Rib II 

TII 

Branches of the cervical plexus 

(rib I removed) 

545

HEAD AND NECK • Arteries of the neck 




Digastric (posterior belly) 

Internal jugular vein (cut) 

Facial artery 



Ascending pharyngeal 

artery 



Carotid sinus 

Superior laryngeal artery 




Thyroid gland 

Common 


Ascending 



Facial artery 



Inferior thyroid artery 













Arteries of the neck (lateral view) 

546


Facial artery 





Facial artery 






Lateral view of the branches of the external carotid artery. 

Volume-rendered angiographic image, with contrast, using multidetector CT 

547

HEAD AND NECK • Root of the neck: arteries 

Contribution to middle scalene from CI 

(sometimes absent) 



Longus colli 


Vertebral body of CVI 


Esophagus 



Dome of right lung under pleura 






Supreme intercostal artery 




Dorsal scapular artery 

(present in 2/3 of individuals) 


Rib I 

Costocervical 

trunk 

Trachea 

Anterior view 

Internal thoracic 

artery 






(present in 1/3 of individuals) 




548










Supreme intercostal artery 




Rib I 



Lateral view 

Vertebral body of CIV 



Right common 


Thyroid gland 





thoracic artery 



Left common 



Anterior view of the root of the neck showing the branches of the subclavian arteries. 

Volume-rendered angiographic image, with contrast, using multidetector CT 

549

HEAD AND NECK • Lymphatics of the neck 

Pre-auricular/parotid nodes 

Facial nodes 

Occipital nodes 

Mandibular node 



Mastoid nodes 

Subparotid node 

Superficial 

cervical nodes 

Posterior lateral 


Submandibular 

nodes 

Jugulodigastric 

node 




vein 

Trapezius 

Transverse 


Deep cervical nodes 

Omohyoid 

Jugulo-omohyoid 

node 

External jugular vein (cut) 

Lymphatic system in the neck 

Subclavicular nodes 

Anterior superficial 


550 

Deep cervical nodes


Area draining to 

right lymphatic duct 

Area draining to 

thoracic duct 


Submandibular 

nodes 

Prelaryngeal nodes 


Pretracheal nodes 

Paratracheal 

nodes 

Areas of lymphatic drainage 

Lymphatic drainage of the thyroid gland, larynx, and trachea 




Hyoid bone 


Thyrohyoid 

Thyroid carilage 

Stylohyoid 


Jugulodigastric node 



Prelaryngeal nodes 

Thyroid gland 

Jugular trunk 

Subclavian trunk 

Pretracheal nodes 

Thoracic duct 

Right subclavian 

vein 

Paratracheal nodes 

Jugulo-omohyoid node 

Internal jugular vein (cut) 

Jugular trunk 

Subclavian trunk 




vein (cut) 

Bronchomediastinal 

trunk 

Bronchomediastinal 

trunk 

Lymphatic system in the neck 

551

HEAD AND NECK • Pharynx 

Frontal sinus 

Soft palate 

Palatine glands 


Torus tubarius 

Hard palate 

Opening of pharyngotympanic tube 

Torus levatorius (fold overlying 

levator veli palatini) 


Nasal cavity 

Pharyngeal recess 

CI 

Oral cavity 

Tongue 

Foramen cecum 

CII 

Salpingopharyngeal fold 

Uvula 


Pharyngeal constrictors 

Genioglossus 


Palatoglossal arch 

Palatopharyngeal arch 

Mandible 

Epiglottis 

Geniohyoid 

Hyoid bone 

Hyo-epiglottic ligament 

Vallecula 


Laryngeal inlet 

Vocal fold 

Transverse 

arytenoid 


Nasopharynx 

Esophagus 

Trachea 

Oropharynx 

Laryngopharynx 

Isthmus of thyroid gland 

Features of the pharynx (lateral view) 

552

Pharynx 8 

Choanae 




Nasal septum 

Torus levatorius 

Valleculae (anterior to epiglottis) 


Opening of pharyngotympanic tube 

Salpingopharyngeal fold 




Uvula 

Prominence caused by superior 

horn of hyoid bone 

Root of tongue 


Prominence caused by superior 

horn of thyroid cartilage 

Nasopharynx 

Oropharynx 


Ary-epiglottic fold 

Piriform fossa 

Cuneiform tubercle 

Fold over internal branch of 


Corniculate tubercle 

Interarytenoid notch 

Prominence over lamina of 

cricoid cartilage 

Esophagus 

Trachea 

Features of the pharynx 

(posterior view with the pharyngeal wall opened) 

Frontal sinus 



Nasal cavity 

Hard palate 


Mandible 

Nasopharynx 

CI 

CII 

Oropharynx 

Regions of the pharynx 

(mouth closed, teeth together). 

Sagittal image taken with Cone Beam 

Computerized Tomography (CBCT) 

technology, viewed in the radiographic mode 

Epiglottis 


553

HEAD AND NECK • Muscles of the pharynx 

Pharyngobasilar fascia 



Buccinator 

Hard palate 



Medial pterygoid plate 

Palatine aponeurosis 

and tendon of 

tensor veli palatini 

Buccinator (cut) 


Cartilaginous part of 

pharyngotympanic tube 



Pterygoid 

hamulus 






Lesser horn of 

hyoid bone 




Salpingopharyngeus 

Cricothyroid 


Trachea 


Esophagus 



Palatopharyngeus 



Muscles of the pharynx (lateral view) 




Hyoglossus (cut) 


raphe 

Styloglossus (cut) 





Hyoid bone 







Hyoid bone 

(greater horn) 

Pharyngeal raphe 



Trachea 

Circular muscle of esophagus 

Longitudinal muscle of esophagus 

Circular muscle of 

esophagus 

Longitudinal muscle 

of esophagus 

Trachea 

554 

Sagittal section through pharynx 

Posterior view


Nasal septum 



Styloid 

process 

Middle concha 


Inferior concha 









Vallate papilla 


Uvula 

Epiglottis 

Pharyngo-epiglottic fold 

Root of tongue 


Interarytenoid notch 

Oblique arytenoid 

Transverse arytenoid 


Posterior crico-arytenoid 

Circular muscle of esophagus 

Longitudinal muscle of esophagus 

Trachea 

Muscles of the posterior wall of the pharynx 

555

HEAD AND NECK • Innervation of the pharynx 



Pharyngeal branch of [V 2 ] 

(in palatovaginal canal) 

Nasopharynx 

-sensory [V 2 ] 

Oropharynx 

-sensory [IX] 


-sensory [X] 




Inferior ganglion of 

vagus nerve [X] 

Pharyngeal branch of [X] 

Superior laryngeal nerve 




Pharyngeal branch of [IX] 


Internal branch of 



Pharyngeal 

branch of [IX] 

Internal 

Jugular vein 

Internal 


Inferior ganglion of 

vagus nerve [X] 

Pharyngeal branch of [X] 









Thyroid gland 

556 







Innervation of the pharynx (lateral view)



(supplies roof of nasopharynx) 




Ascending palatine artery 

Tonsillar branch 

Facial artery 



Ascending 

pharyngeal artery 





External 


Superior 

laryngeal 


Inferior 

constrictor 

Middle 

constrictor 

Superficial 

temporal vein 

Inferior laryngeal 

artery 


Pharyngeal branches 


Facial artery 

and vein 

Inferior alveolar 



Venous drainage of the pharynx 






Arterial supply to the pharynx 

557

HEAD AND NECK • Larynx 

Hyoid bone 



Position of oblique line on thyroid cartilage 

Thyroid notch 


Median cricothyroid ligament 


Trachea 

Position of larynx in the neck as it relates to the surface 

Hyoid bone 

Lateral thyrohyoid ligament 

Triticeal cartilage 


Epiglottis 


Aperture for internal branch of superior 

laryngeal nerve and associated artery 

Superior horn 


Median thyrohyoid ligament 

Superior thyroid tubercle 

Oblique line 


Inferior thyroid tubercle 

Inferior horn 



Cricothyroid joint 

Trachea 

Cricovocal membrane (lateral 

cricothyroid ligament, conus elasticus) 

Cricotracheal ligament 

External features of the larynx (anterolateral view) 

558

Larynx 8 


Medial 


corniculate cartilage 

Hyoid bone 


epiglottic cartilage 

Vocal process 

Colliculus 

Apex 

Epiglottis 

Epiglottic tubercle 

Quadrangular 

membrane (left) 

Cuneiform cartilage Epiglottis 


Corniculate cartilage 

Arytenoid cartilage 

Vestibular ligament (cut away) 

Depression for 

attachment of 

vestibular ligament 


for cricoid 

Vocal process 

Depression for attachment 

of vocalis muscles 

Arytenoid cartilages 

Lateral 

Muscular process 

Epiglottis 

Thyroid 

cartilage 

Vocal ligament 

Median cricothyroid 

ligament 

Quadrangular membrane (anterolateral view) 



cricothyroid ligament, conus elasticus) 


with inferior horn of 


Thyro-epiglottic ligament 

Cuneiform 

cartilage 

Corniculate 

cartilage 

Arytenoid 

cartilage 

Thyroid notch 

Thyroid 

cartilage 

Epiglottis 



cricothyroid ligament, 

conus elasticus) 

Inferior horn 

Superior horn 



with inferior horn of 


Cartilages of the larynx (anterolateral view) 

Quadrangular membrane 


Vestibular ligament 

Vocal process of arytenoid 

Cuneiform cartilage 

Corniculate cartilage 

Muscular process of arytenoid 

Fibro-elastic membrane of the larynx (superior view) 

559

HEAD AND NECK • Laryngeal cavity 

Hyoid bone 

Epiglottis 


Laryngeal saccule 

Thyrohyoid 

membrane 

Cut edge of mucosa 


Cuneiform 

tubercle 

Corniculate 

tubercle 

Cut edge of right thyroid lamina 

Laryngeal saccule 

Laryngeal ventricle 

Vestibular fold 

(mucosa overlying 

vestibular ligament) 

Interarytenoid 

notch 

Infraglottic space 

Muscular process of 

arytenoid cartilage 


Cricoid arch 

Vocal fold 

(mucosa overlying 

vocal ligament) 

Trachea 

Posterolateral view 

Epiglottis 

Posterior view (cutaway) 

Hyoid bone 

Vocal fold 




Rima glottidis 

Rima vestibuli 

Interarytenoid fold 


Epiglottis 



Superior horn 

Tongue 

Epiglottis 

Anterior 



(false vocal cord) 








Posterior 

Vocal fold 

(true vocal cord) 

Rima glottidis 

(opening between 

vocal folds) 

Laryngeal ventricle 

Vocal fold 

Infraglottic space 


Vestibule 


Trachea 

Piriform recess 

560 

Superior view through the laryngeal inlet 

Sagittal section through laryngeal cavity


Epiglottis 

Hyoid bone 


Hyoid bone 

Epiglottis 

Superior horn 



Cut edge 

of mucosa 




Ary-epiglottic 


Saccule 



Cricothyroid 

Straight part 

Oblique part 

Trachea 


Thyro-epiglottic 


Thyro-arytenoid 

Lateral view 

Posterolateral view 

Lateral crico-arytenoid 




Cricothyroid 

Straight part 

Oblique part 

Vocalis 

Ary-epiglottic 

Cricovocal membrane 

(lateral cricothyroid ligament, 

conus elasticus) 

Lateral crico-arytenoid 

Vocal process of arytenoid 

Superior horn 


Muscular process of arytenoid 



Superior view 

561

HEAD AND NECK • Innervation of the larynx 



Inferior vagal 

ganglion 

Superior laryngeal 

nerve 



Thyrohyoid 

membrane 

Superior thyroid 

artery 

Cricothyroid 

Right recurrent 




Inferior vagal ganglion 


Internal laryngeal nerve 

External laryngeal nerve 


Position of vocal folds 

Median cricothyroid 

ligament 

Cricothyroid 


Trachea 



Trachea 


Internal laryngeal nerve 



Superior laryngeal artery 

External laryngeal nerve 



Inferior laryngeal artery 


Esophagus 





Lateral view 



Aortic arch 






Esophagus 


Anterior view 


562


Hyoid bone 


Position of oblique line on thyroid cartilage 

Right lobe of thyroid gland 

Isthmus of thyroid gland 

Thyroid notch 



Arch of cricoid 

Left lobe of thyroid gland 

Trachea 

Thyroid gland as it relates to surface 

Hyoid bone 



Thyroid notch 




Cricothyroid 


Right lobe of 

thyroid gland 

Isthmus of 

thyroid gland 

Cricopharyngeus 

Superior 

parathyroid gland 

Left lobe of 

thyroid gland 

Esophagus 

Right lobe of 

thyroid gland 

Inferior parathyroid gland 

Trachea 

Trachea 

Anterior view 


563

HEAD AND NECK • Vasculature of the thyroid gland 



Superior thyroid vein 

Hyoid bone 



Thyrohyoid 

Superior thyroid vein 





Cricothyroid 



Middle thyroid vein 


Middle thyroid vein 





Trachea 





Inferior thyroid veins 




Aortic arch 



Anterior view 

564


Right external carotid artery 





Tip of great horn of hyoid bone 

Right internal carotid artery 




Left superior thyroid artery 


Cricopharyngeus 

Superior parathyroid gland 




Inferior parathyroid gland 



Esophagus 



Right inferior thyroid artery 









Trachea 



Aortic arch 





565

HEAD AND NECK • Nose and paranasal sinuses 

Frontal bone 

Frontal process 



Nasal bone 


of septal cartilage 

Superior margin of 


Accessory nasal 

cartilage 

Major alar cartilage 

Frontal 

sinuses 



Minor alar cartilages 

External nose 

Lateral crus of 

major alar cartilage 

Septal nasal cartilage 

Connective tissue 

Medial crus of 

major alar cartilage 

Maxillary sinuses 

Anterior nasal spine of maxilla 


Inferior view 

Paranasal sinuses (anterior view) 

Superior concha 

Crista galli 


Cranial cavity 

Frontal sinus 

Root 

Dorsum 

Ala 

Apex 

Naris 

Nasal septum 


Frontal sinus 

Orbit 


Ethmoidal bulla 

Middle concha 

Uncinate 


ethmoid bone 

Nasal cavities 



Vomer 

566 

Surface anatomy of nose and paranasal sinuses (lateral view) 

Palatine process of maxillary bone 

Oral cavity 

Coronal section through nasal cavity (posterior view)


Frontal process of maxillary bone 

Frontal bone 

Lacrimal bone 


Nasal spine of frontal bone 

Crista galli 

Frontal bone 

Frontal sinus 


Spheno-ethmoidal recess 

Perpendicular plate of ethmoid bone 


Nasal bone 

Middle concha 

Hypophysial fossa 

Nasal bone 

Basilar part of 

occipital bone 


Vomer 

Incisive canal 

Minor alar cartilage 

Lateral process of 


Medial and lateral plates of pterygoid 


Nasal crest of palatine bone 

Pterygoid hamulus Lesser palatine foramen 

of sphenoid bone 

Perpendicular plate of Greater palatine foramen 

palatine bone 

Uncinate process of 

Horizontal plate of palatine bone 

ethmoid bone 

Nasal crest of maxillary bone 


Incisor crest of maxillary bone 

Palatine process of 

maxillary bone 

Septal cartilage 

Major alar cartilage 

Infundibulum opening of 

frontonasal duct 

Opening to 

frontonasal duct 

Bones of the lateral wall 

Ethmoidal bulla 

Openings of middle ethmoidal cells 

Superior concha (cut away) 

Openings to posterior ethmoidal cells 

Opening of sphenoidal sinus 



Bones of the medial wall 

Vaginal process of medial pterygoid plate 

Ala of vomer 

Vomer 

Medial plate of pterygoid 


Uncinate 


ethmoid bone 




nasolacrimal duct 




(cut away) 

Middle concha (cut away) 



Ethmoidal process of inferior concha 

Hiatus semilunar Opening between bulla and uncinate process 

(opening of maxillary sinus) 

Concha cut away 

Choanae 

Pterygoid hamulus of 

sphenoid bone 





567

HEAD AND NECK • Nasal cavity: mucosal linings 

Middle nasal concha 

Middle nasal meatus 

Superior nasal concha 

Superior nasal meatus 

Nasal septum 

Crista galli 

Frontal sinus 

Frontal sinus 

Spheno-ethmoidal recess 

Spheniodal sinus 


Limen nasi 

Nasal vestibule 



Choanae 


Inferior nasal meatus 

Horizontal plate of 

palatine bone 





Anterior nasal spine of maxilla 

Lateral wall of the nasal cavity 

Medial wall of the nasal cavity 

Middle nasal concha (cut away) 

Superior nasal concha (cut away) 

Frontal sinus 

Opening to posterior ethmoidal cells into 

lateral wall of superior meatus 

Opening of sphenoidal sinus into 

spheno-ethmoidal recess 

Infundibulum opening of 

frontonasal duct that drains 

the frontal sinus and anterior 

ethmoidal cells 


(cut away) 

Spheniodal sinus 

Opening of middle 

ethmoidal cells 

Hiatus semilunaris 

Opening of nasolacrimal duct 

Opening of maxillary sinus in floor of 

hiatus semilunaris 

568 

Lateral wall of the nasal cavity, concha cut away


External nasal 

artery from 

anterior 

ethmoidal 

Nasal vein in foramen caecum 

Anterior ethmoidal artery and vein 

Posterior ethmoidal artery and vein 


Sphenopalatine 


Septal branches of 

sphenopalatine 



posterior ethmoidal 



anterior ethmoidal 


A 

B 

Alar branch of lateral 

nasal artery and vein 

Greater palatine artery and vein 


Lateral branches 

of sphenopalatine 


Terminal part of greater 

palatine artery and vein 

Vasculature of the nasal cavities 

A. Lateral wall of right nasal cavity B. Medial wall of right nasal cavity 

Septal branches from nasal 

vessels from superior labial 


Anterior ethmoidal nerve 


Septal branch of anterior 

ethmoidal nerve 

External nasal 

branch of anterior 

ethmoidal nerve 



Olfactory nerve [I] 

(septal branches) 

A 


lateral nasal nerves 

B 

Internal nasal branches 

of infra-orbital nerve 


lateral nasal nerves 

Nasopalatine nerve 

Nasal branch of anterior 

superior alveolar nerve 

Innervation of the nasal cavities 

A. Lateral wall of right nasal cavity B. Medial wall of right nasal cavity 

569

HEAD AND NECK • Sinus imaging 







Orbit 


Superior meatus 

Middle meatus 


Inferior meatus 

Oral cavity 

Oral cavity 


Anterior view of the maxillary sinus and ethmoidal cells. 


Middle concha 


Anterior view looking into the nasal cavity showing the 

relationship of various structures. 




Sphenoidal 

sinuses 

Frontal sinus 



Anterior view of the frontal sinuses. 


Anterior view of the sphenoidal sinuses showing their 

relationship to the nasal cavity. 


570





Nasopharynx 

Axial section showing the relationship among the nasal 

cavity, nasopharynx, and maxillary sinuses. 



Orbit 





Axial section showing the ethmoidal cells and the sphenoidal 

sinuses and the relationship of these structures to the orbit. 


571

HEAD AND NECK • Oral cavity: bones 

Intermaxillary suture 

Pterygoid hamulus of 

sphenoid bone 

Sphenoid bone 




Posterior nasal spine 





Mandibular symphysis 

Superior 

mental spines 

Coronoid 

process 

Retromolar triangle 

Lateral plate 

of pterygoid 

process 

Mandible (superior view) 

Condylar 

process 

Sublingular fossa 

Mylohyoid 

line 


Superior mental spines 


Vomer 



Medial plate of 

pterygoid process 

Temporal bone 

Roughening for attachment 

of levator veli palatini 

Scaphoid fossa for attachment 

of tensor veli palatini 


(closed by cartilage) 

Submandibular fossa 

Inferior 

mental spines 

Inferior view of skull 


Mandible (posterior view) 

Lingula 



Retromolar fossa 

Alveolar arch 

Ramus 

Mandibular 

foramen 

Retromolar triangle 

Shallow groove for 

lingual nerve 

Angle 

Body 

Submandibular fossa 

Mylohyoid line 

Superior 

mental 

spine 



Inferior mental spine 

Mandible (lateral view) 

Mandible (medial view) 

572

Teeth 8 

Central incisors 

Lateral incisors 

Canines (cuspid) 

Premolars (bicuspid) 

Molars 

Adult permanent teeth 


Roots related to 

maxillary sinus 

Incisors 

Oral 

Distal 

Mesial 

Vestibular 

Canines 

Molars 

Roots related to 

mandibular canal 

Deciduous (baby) teeth 


Adult permanent teeth with roots exposed, first molar pulled out 

Central Lateral Canines 

1 2 

1 2 3 

Incisors Premolars Molars 

Adult upper and lower permanent teeth (vestibular view) 

573

HEAD AND NECK • Teeth: imaging 


Zygomatic process of temporal bone 


Maxilla 

CI 

CI 

Maxilla 


Hyoid bone 

CIV 

CIV 

Hyoid bone 


View of the left side of the face showing the craniofacial 

structures including the teeth. 


technology, viewed in the Maximum Intensity Projection (MIP) mode, 

which combines a radiographic view with a view of surface structures 

View of the right side of the face showing the craniofacial 

structures including the teeth. 


technology, viewed in the Maximum Intensity Projection (MIP) mode, 

which combines a radiographic view with a view of surface structures 


External acoustic 

meatus 



574 

Incisors 

Premolars 

Canine 

Molars 

Panoramic view of the teeth (dentition), which also shows the maxillary 

sinuses and mandibular condylar processes. 

Image taken with Cone Beam Computerized Tomography (CBCT) technology


Papilla 

Interproximal space 

Enamel 

Crown 

Dentine 

Pulp cavity 

Gingiva (gum) 

Neck 

Root canal containing 


Alveolar bone 

Periodontium 

Root 

Cement 

Apical foramen 

Mandible 

Inferior alveolar vessels 

and nerve 

Anatomy of teeth 

Inside, lingual or sagittal view of 

the right side of the maxillary and 

mandibular alveolar processes in 

occlusion (teeth together). 

Image taken with Cone Beam 

Computerized Tomography (CBCT) 

technology viewed in the surface mode 

PM1 

PM2 

M1 

M2 


Mandible 

Canals containing the 

dental branches of the 

inferior alveolar nerve 

Root apex 

575

HEAD AND NECK • Vessels and nerves supplying teeth 

Cavernous sinus in cranial cavity 





Infra-orbital artery and vein 

Anterior superior alveolar 


Posterior superior alveolar 




Pterygoid plexus 


mandibular foramen 

Inferior alveolar artery and 

vein in mandibular canal 


Incisive branches of 

inferior alveolar artery and vein 

Mental branches of 



Facial vein 

Dental branches of 


Arteries and veins supplying teeth 





Posterior superior alveolar nerve 






Anterior superior alveolar nerve 

Middle superior alveolar nerve 

Mandibular nerve in 

infratemporal fossa [V 3 ] 

Lingual nerve 


Superior alveolar plexus 


mandibular foramen 

Inferior alveolar nerve in 

mandibular canal 

Incisive nerve 

Dental branches of inferior alveolar nerve 

Mental nerve 


576 

Innervation of the teeth


Teeth 

Anterior superior alveolar nerve (from [V 2 ]) 

Gingivae 

Nasopalatine nerve (from [V 2 ]) 

Middle superior alveolar nerve (from [V 2 ]) 

Anterior superior alveolar 

nerve (from [V 2 ]) 

Middle superior alveolar 


Posterior superior alveolar nerve (from [V 2 ]) 



(from [V 2 ]) 

Anterior superior alveolar nerve 

Middle superior alveolar nerve 

Posterior superior alveolar nerve 




Upper teeth and gums 

Lingual nerve 

Buccal nerve 

Lingual nerve (from [V 3 ]) 

Incisive branch 

Mental nerve 

Inferior alveolar nerve (from [V 3 ]) 

Buccal nerve 

(from [V 3 ]) 

Mental nerve from inferior 

alveolar nerve (from [V 3 ]) 

Incisive branch of inferior alveolar nerve (from [V 3 ]) 

Lower teeth and gums 

577

HEAD AND NECK • Muscles and salivary glands of the oral cavity 

Superior mental spines 


Geniohyoid attachment to 

inferior mental spines 

Mylohyoid line 

Geniohyoid 

Greater horn of hyoid 

Mylohyoid 

Body of hyoid 

Free posterior margin 

of mylohyoid 

Mylohyoid 

Genioglossus attachment 

to superior mental spines 

Mylohyoid and geniohyoid 

Geniohyoid 

Mylohyoid 

Palatoglossus 

Hyoid 

Superior 

mental spine 

Genioglossus 

Inferior 

mental spine 

Hyoglossus 

Genioglossus 

Geniohyoid 

Hyoid 

Greater horn of hyoid 


Body of hyoid 

Submandibular duct 

Mylohyoid 

Genioglossus and hyoglossus 


Lingual nerve 

Styloglossus 


Small ducts of 

sublingular gland 

Styloid 

process 

Stylohyoid 

ligament 

Middle 

constrictor 

Hyoglossus 

Deep 

Superficial 


Genioglossus 

Mylohyoid 

Hyoglossus 


Genioglossus 

Mylohyoid 

Deep 

Superficial 



Submandibular and sublingual glands 

Lateral view 

578



Styloglossus 




Chorda tympani (from [VII]) 





C1 

Genioglossus 


branch of occipital 

artery 


Mylohyoid (cut) 

Geniohyoid 

C1 branch to geniohyoid 

Hyoglossus 

Deep lingual vein 

Dorsal lingual vein 





Arteries, veins, and nerves of the tongue 

Sensory 

Anterior two-thirds (oral) 

• general sensation 

Mandibular nerve [V 3 

] via lingual nerve 

• special sensation (taste) 

Facial nerve [VII] via chorda tympani 

Posterior one-third (pharyngeal) 

• general and special sensation (taste) 


Palatoglossus – vagus nerve [X] 

Motor 

Styloglossus – hyoglossal nerve [XII] 

Hyoglossal 

nerve [XII] 

Intrinsic muscle 

Genioglossus 

Innervation of the tongue 

Hyoglossus – hyoglossal nerve [XII] 

579

HEAD AND NECK • Tongue 

Apex of tongue 

Lower lip 

Central incisor 


Oral vestibule 

Facial artery and vein 

Filiform papillae 

Buccinator 

Fungiform papillae 


Median sulcus 

Foliate papillae 

3rd molar 



Palatoglossus 


Lateral glosso-epiglottic fold 


Terminal sulcus 

Vallate papillae 



Median glosso-epiglottic fold 


Superior longitudinal muscle 

Vallecula 

Genioglossus 

Vertical and transverse muscles 

Inferior longitudinal muscle 

Hyoglossus 

Epiglottis 

Styloglossus 

Horizontal section showing superior view of tongue 

Vertical and transverse muscles 


Superior longitudinal muscles 


Buccinator 

Oral vestibule 


Mandible 

Mandible 

Hyoid 

Geniohyoid 

Genioglossus 

Mylohyoid 

Paramedian sagittal section through tongue 

580 

Sublingual salivary gland 

Lingual nerve 



Vallecula 

Mylohyoid 

Platysma 

Submandibular lymph node 

Epiglottis 


Facial artery and vein 

Submandibular salivary gland 





Geniohyoid 

Coronal section through tongue (posterior view) Septum


Incisive papilla overlying incisive fossa 



Palatine rugae 

Hard palate 

Greater palatine artery 

Greater palatine nerve 




Lesser palatine nerve 

Lesser palatine artery 


raphe 

Hard palate 

Palatine aponeurosis and 

tendon of tensor veli palatini 


Uvula 

Palatine arteries and nerves 






Palatoglossus 





Genioglossus 

Uvula 



Epiglottis 

Pharyngo-epiglottic fold 


Nasal septum 

Branches from ascending palatine 

branch of facial artery and palatine 

branch of ascending pharyngeal 

artery 



Muscles of the soft palate (sagittal section) 

Muscles of the soft palate (posterior view) 

581

HEAD AND NECK • Palate 

Palatine glands 


Greater palatine artery 

Palatine aponeurosis 

Lesser palatine 

artery and nerve 



Anterior margin of 

oropharyngeal isthmus 


Buccinator 


raphe 

Palatoglossus 



Palatine 

tonsil 

Uvula 

Palatopharyngeal arch Uvula 


Posterior wall of oropharynx 

Open mouth showing soft palate 



Roof of oral cavity 

Underside of tongue 

Frenulum of tongue 

Lingual vein 

Opening of left submandibular duct 

Frenulum of tongue 

Lingual glands 

Deep lingual vein 

Deep lingual artery 

Lingual nerve 



Sublingual caruncle 

Sublingual caruncles 

Sublingual fold overlying sublingual gland 

Sublingual glands (anterosuperior view) 

582 

Opening of left submandibular duct 

Sublingual fold 

Inferior surface of tongue and floor of oral cavity






Mandibular nerve[V 3 ] 





ganglion 


All glands above level of 

oral fissure innervated by 

greater petrosal of [VII] 



Palatine nerves 

Deep 

petrosal 

nerve 


Internal 

carotid plexus 

Tympanic 

nerve 

Tympanic 

plexus 


nerve [IX] 


Glands on palate 

Otic ganglion 

Lesser palatine nerve 

Inferior 

ganglion 


nerve 

Lingual 

glands 

Uvula 

Lingual 

nerve 

Chorda 

tympani 

Internal 

carotid 

artery 




Internal 

carotid 

nerve 

Parotid gland 

innervated by 

lesser petrosal 

of [IX] 

Submandibular 

gland 

Facial artery 

Superior cervical 

ganglion 

All glands below level of 

oral fissure innervated by 

chorda tympani of [VII] 






Visceral efferent (motor) innervation of glands related to the oral cavity 

583

HEAD AND NECK • Cranial nerves 

Olfactory nerve [I] 

Special sensory – smell 


Special sensory – vision 


Somatic motor – five extra-ocular muscles (superior rectus, medial rectus, 

inferior oblique, inferior rectus, and levator palpebrae superioris) 

Visceral motor – ciliary muscles and sphincter pupillae muscles 


Somatic motor – one extra-ocular 

muscle (superior oblique) 


Somatic motor – one extra-ocular 

muscle (lateral rectus) 

Trigeminal nerve [V] sensory root 

Somatic sensory – eyes, orbital contents, face, 

sinuses, teeth, nasal cavities, oral cavity, nasopharynx, 

dura, anterior part of external ear, and part of 

external acoustic meatus 

V 3 

V 2 

V 1 

V 3 

Trigeminal nerve [V] motor root 

Branchial motor – the four muscles of mastication 

(medial pterygoid, lateral pterygoid, masseter, temporalis) 

and mylohyoid, anterior belly of digastric, tensor tympani, 

and tensor veli palatini 

Overview of cranial nerves 

Efferent (motor) fibers 

Afferent (sensory) fibers 

584



Branchial motor – all muscles of facial expression, and 

stapedius, stylohyoid, and posterior belly of digastric 

Facial nerve [VII] (intermediate nerve) 

Special sensory – taste (anterior 2/3 of tongue) 

Somatic sensory – part of external acoustic meatus and 

deeper parts of auricle 

Visceral motor (parasympathetic) – secretomotor to all 

salivary glands except for parotid gland; all mucous glands 

associated with the oral and nasal cavities; lacrimal gland 


Special sensory – hearing and balance 


Special sensory – taste (posterior 1/3 of tongue) 

Somatic sensory – posterior 1/3 of tongue, oropharynx, palatine tonsil, 

middle ear, pharyngotympanic tube, and mastoid air cells 

Branchial motor – stylopharyngeus 

Visceral motor – (parasympathetic) – secretomotor to the 

parotid gland 

Visceral sensory – from carotid body and sinus 



Somatic motor – all muscles of the 

tongue except palatoglossus 


Somatic motor – sternocleidomastoid 

and trapezius 

Somatic sensory – larynx, laryngopharynx, deeper parts of 

auricle and part of external acoustic meatus 

Special sensory – taste from epiglottis and pharynx 

Branchial motor – all muscles of pharynx except for 

stylopharyngeus; all muscles of the soft palate except 

for tensor veli palatini, all intrinsic muscles of larynx 

Visceral motor – (parasympathetic) – thoracic viscera and 

abdominal viscera to end of midgut 

Visceral sensory – thoracic viscera and abdominal viscera 

to end of midgut, chemo- and baroreceptors 

(and in some cases carotid body) 

585

HEAD AND NECK • Visceral motor pathways in the head 

Lacrimal 

gland 

Infra-orbital 

nerve 


Short cilary nerves 

Long cilary nerves 





nerve 

Nasocilary nerve 




Ophthalmic nerve [V 1] 

Maxillary nerve [V 2] 


Mandibular nerve [V 3] 






nerve [IX] 

Glands in nasal cavities, 

palate, and sinuses 



ganglion 




Palatine nerve 

Otic 

ganglion 


nerve 

Lingual nerve 


Chorda 

tympani 


Internal 

carotid 

artery 

Internal 

carotid 

nerve 

Tympanic 

nerve 

Inferior 

ganglion 


nerve 

Parotid gland 

Submandibular 

gland 

Facial artery 

Superior cervical 

ganglion 






Summary of visceral efferent (motor) pathways in the head 

586

Tables 8 

External foramina of the skull 

Foramen 

Anterior view 

Supra-orbital foramen 



1 

2 

3 

Structures passing through foramen 

Supra-orbital nerve and vessels 

Infra-orbital nerve and vessels 

Mental nerve and vessels 

Lateral view 

Zygomaticofacial foramen 

4 


Superior view 


5 


1 

2 

4 

3 

5 

587

HEAD AND NECK • Tables 

External foramina of the skull 

Foramen 

Inferior view 

Incisive foramina 


Lesser palatine foramina 

Pterygoid canal 

Foramen ovale 



Carotid canal 


Condylar canal 




1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

Structures passing through foramen 

Nasopalatine nerve; sphenopalatine vessels 

Greater palatine nerve and vessels 

Lesser palatine nerves and vessels 

Pterygoid nerve and vessels 

Mandibular nerve [V 3 ]; lesser petrosal nerve 


Filled with cartilage 

Internal carotid artery and nerve plexus 

Continuation of brain and spinal cord; vertebral arteries and nerve plexuses; anterior spinal artery; 

posterior spinal arteries; roots of accessory nerve [XI]; meninges 


Hypoglossal nerve [XII] and vessels 

Internal jugular vein; inferior petrosal sinus; glossopharyngeal nerve [IX]; vagus nerve [X]; accessory 

nerve [XI] 


Internal foramina of the skull 

Anterior cranial fossa 


Olfactory foramina in 

cribriform plate 


Optic canal 


1 

2 

3 

4 

Emissary veins to nasal cavity 


Optic nerve [II]; ophthalmic artery 

Oculomotor nerve [III]; trochlear nerve [IV]; ophthalmic division of the trigeminal nerve [V 1 ]; abducent 

nerve [VI]; ophthalmic veins 

Foramen rotundum 5 Maxillary division of the trigeminal nerve [V 2 ] 

Foramen ovale 


Hiatus for the greater 


Hiatus for the lesser 


6 

7 

8 

9 

Mandibular division of the trigeminal nerve [V 3 ]; lesser petrosal nerve 









Condylar canal 

10 

11 

12 

13 

14 

End of brainstem/beginning of spinal cord; vertebral arteries; spinal roots of the accessory nerve; meninges 

Facial nerve [VII]; vestibulocochlear nerve [VIII]; labyrinthine artery 

Glossopharyngeal nerve [IX]; vagus nerve [X]; accessory nerve [XI]; inferior petrosal sinus, sigmoid sinus 

(forming internal jugular vein) 

Hypoglossal nerve [XII]; meningeal branch of the ascending pharyngeal artery 

Emissary vein 

588

Tables 8 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

13 

12 

11 

1 

2 

3 

4 

5 

7 

6 

11 

12 

10 

14 

13 

9 

8 

589


Muscles of the face 


Orbital group 


—Palpebral part 

1 Medial palpebral ligament Lateral palpebral raphe Facial nerve [VII] Closes the eyelids 

gently 

—Orbital part 

2 

Nasal part of frontal bone; 

frontal process of maxilla; 

medial palpebral ligament 

Fibers form an uninterrupted 

ellipse around 

orbit 


Closes the eyelids 

forcefully 


3 

Medial end of the superciliary 

arch 

Skin of the medial half of 

eyebrow 


Draws the eyebrows 

medially and 

downward 

Nasal group 

Nasalis 

—Transverse part 

—Alar part 

Procerus 


4 Maxilla just lateral to nose Aponeurosis across 

dorsum of nose with 

muscle fibers from the 

other side 

5 

6 

7 


Compresses nasal 

aperture 

Maxilla over lateral incisor Alar cartilage of nose Facial nerve [VII] Draws cartilage 

downward and 

laterally opening 

nostril 

Nasal bone and upper part 

of lateral nasal cartilage 

Maxilla above medial 

incisor 

Skin of lower forehead 

between eyebrows 

Mobile part of the nasal 

septum 



Draws down medial 

angle of eyebrows 

producing transverse 

wrinkles over bridge of 

nose 

Pulls nose inferiorly 

1 

2 

3 6 

4 

5 

7 

590

Tables 8 



Oral group 


1 Oblique line of mandible 

below canine, premolar, 

and first molar teeth 

Skin at the corner of 

mouth and blending with 

orbicularis oris 


Draws corner of mouth 

down and laterally 

Depressor labii 

inferioris 

2 

Anterior part of oblique line 


Lower lip at midline; 

blends with muscle from 

opposite side 


Draws lower lip 

downward and laterally 

Mentalis 

3 

Mandible inferior to incisor 

teeth 

Skin of chin 


Raises and protrudes 

lower lip as it wrinkles 

skin on chin 

Risorius 

4 

Fascia over masseter 

muscle 

Skin at the corner of the 

mouth 


Retracts corner of 

mouth 


5 

Posterior part of lateral 

surface of zygomatic bone 

Skin at the corner of the 

mouth 


Draws the corner of 

the mouth upward and 

laterally 


6 

Anterior part of lateral 

surface of zygomatic bone 

Upper lip just medial to 

corner of mouth 


Draws the upper lip 

upward 


7 

Infra-orbital margin of 

maxilla 

Skin of upper lateral half 

of upper lip 


Raises upper lip; helps 

form nasolabial furrow 

Levator labii 

superioris alaeque nasi 

8 

Frontal process of maxilla 

Alar cartilage of nose 

and upper lip 


Raises upper lip and 

opens nostril 


9 

Maxilla below infra-orbital 

foramen 

Skin at the corner of 

mouth 


Raises corner of 

mouth; helps form 

nasolabial furrow 


10 

From muscles in area; 

maxilla and mandible in 

midline 

Forms ellipse around 

mouth 


Closes lips; protrudes 

lips 

Buccinator 

11 

Posterior parts of maxilla 

and mandible; 

pterygomandibular raphe 

Blends with orbicularis 

oris and into lips 


Presses the cheek 

against teeth; 

compresses distended 

cheeks 

8 

6 

7 

5 

4 

1 

2 

9 

10 

11 

3 

591




Other muscles or groups 

Anterior auricular 

1 Anterior part of temporal 

fascia 

Into helix of ear 


Draws ear upward 

and forward 

Superior auricular 

2 


on side of head 

Upper part of auricle 


Elevates ear 


3 

Mastoid process of 

temporal bone 

Convexity of concha of 

ear 


Draws ear upward 

and backward 

Occipitofrontalis 

—Frontal belly 

4 

Skin of eyebrows Into galea aponeurotica Facial nerve [VII] Wrinkles forehead; 

raises eyebrows 

—Occipital belly 

5 

Lateral part of superior 

nuchal line of occipital 

bone and mastoid 

process of temporal 

bone 

Into galea aponeurotica 


Draws scalp 

backward 

Extrinsic (extra-ocular) muscles 

Muscle Origin 

Insertion 

Innervation Function 


superioris 

1 Lesser wing of sphenoid 

anterior to optic canal 

Anterior surface of tarsal 

plate; a few fibers to skin 

and superior conjunctival 

fornix 

Oculomotor nerve 

[III]—superior branch 

Elevation of upper eyelid 


2 

Superior part of common 

tendinous ring 

Anterior half of eyeball 

superiorly 


[III]—superior branch 

Elevation, adduction, 

medial rotation of eyeball 


3 

Inferior part of common 



inferiorly 


[III]—inferior branch 

Depression, adduction, 

lateral rotation of eyeball 

Medial rectus 

4 

Medial part of common 



medially 



Adduction of eyeball 


5 

Lateral part of common 



laterally 


Abduction of eyeball 


6 

Body of sphenoid, 

superior and medial to 

optic canal 

Outer posterior quadrant of 

eyeball (superior surface) 


Depression, abduction, 

medial rotation of eyeball 


7 

Medial floor of orbit 

posterior to rim; maxilla 

lateral to nasolacrimal 

groove 

Outer posterior quadrant of 

eyeball (inferior surface) 



Elevation, abduction, 

lateral rotation of eyeball 

592

Tables 8 

4 

2 

1 

5 

3 

1 

2 

7 

6 

3 

5 

4 

593


Intrinsic muscles of the eye 

Muscle 

Location Innervation Function 

Ciliary 

1 

Muscle fibers in the ciliary body 

Parasympathetics from the 


Constricts ciliary body, relaxes tension on 

lens, lens become more rounded 

Sphincter 

pupillae 

2 

Circularly arranged fibers in the iris 

Parasympathetics from the 


Constricts pupil 

Dilator pupillae 

3 

Radially arranged fibers in the iris 

Sympathetics from the superior 

cervical ganglion (T1) 

Dilates pupil 

Muscles of the middle ear 


Tensor tympani 

1 Cartilaginous part of 

pharyngotympanic tube, greater 

wing of sphenoid, its own bony 

canal 

Upper part of handle 

of malleus 

Branch from mandibular 

nerve [V 3 ] 

Contraction pulls handle of 

malleus medially, tensing 

tympanic membrane 

Stapedius 

2 Attached to inside of pyramidal 

eminence 

Neck of stapes 

Branch of facial nerve [VII] 

Contraction pulls stapes 

posteriorly, preventing 

excessive oscillation 

1 

1 

3 

2 

2 

594

Tables 8 

Muscles of mastication 


Masseter 

1 Zygomatic arch and maxillary 

process of the zygomatic bone 

Lateral surface of ramus of 

mandible 

Masseteric nerve from the 

anterior trunk of the 


Elevation of 

mandible 

Temporalis 

2 

Bone of temporal fossa and 

temporal fascia 

Coronoid process of mandible 

and anterior margin of ramus 

of mandible almost to last 

molar tooth 


from the anterior trunk of 

the mandibular nerve [V 3 ] 

Elevation and 

retraction of 

mandible 

Medial 

pterygoid 

3 

Deep head—medial surface of 

lateral plate of pterygoid process 

and pyramidal process of palatine 

bone; superficial head—tuberosity 

of the maxilla and pyramidal 

process of palatine bone 

Medial surface of mandible 

near angle 

Nerve to medial pterygoid 

from the mandibular nerve 

[V 3 ]. 

Elevation and 

side-to-side 

movements of the 

mandible 

Lateral 

pterygoid 

4 

Upper head—roof of infratemporal 

fossa; lower head—lateral surface 

of lateral plate of the pterygoid 

process 

Capsule of temporomandibular 

joint in the region of attachment 

to the articular disc and to the 

pterygoid fovea on the neck of 

mandible 

Nerve to lateral pterygoid 

directly from the anterior 

trunk of the mandibular 

nerve [V 3 ] or from the 

buccal branch 

Protrusion and 

side-to-side 

movements of the 

mandible 

1 

2 

3 4 

595


Anterior triangle of neck (suprahyoid and infrahyoid muscles) 


Stylohyoid 

1 Base of styloid process Lateral area of body of 

hyoid bone 


Pulls hyoid bone upward in 

a posterosuperior direction 

Digastric 

—Anterior belly 

2 

Digastric fossa on lower 

inside of mandible 

Attachment of tendon 

between two bellies to 

body of hyoid bone 

Mylohyoid nerve from 

inferior alveolar branch of 


Opens mouth by lowering 

mandible; raises hyoid 

bone 

—Posterior belly 

3 

Mastoid notch on medial 

side of mastoid process 



Pulls hyoid bone upward 

and back 

Mylohyoid 

4 

Mylohyoid line on 

mandible 

Body of hyoid bone and 

fibers from muscle on 

opposite side 

Mylohyoid nerve from 

inferior alveolar branch of 


Support and elevation of 

floor of mouth; elevation of 

hyoid 

Geniohyoid 

5 

Inferior mental spine on 

inner surface of mandible 

Anterior surface of body of 

hyoid bone 

Branch from anterior 

ramus of C1 (carried along 

the hypoglossal nerve 

[XII]) 

Fixed mandible elevates 

and pulls hyoid bone 

forward; fixed hyoid bone 

pulls mandible downward 

and inward 

Sternohyoid 

6 

Posterior aspect of 

sternoclavicular joint and 

adjacent manubrium of 

sternum 

Body of hyoid bone medial 

to attachment of omohyoid 

muscle 

Anterior rami of C1 to C3 

through the ansa 

cervicalis 

Depresses hyoid bone 

after swallowing 

Omohyoid 

7 

Superior border of 

scapula medial to 

suprascapular notch 

Lower border of body of 

hyoid bone just lateral to 

attachment of sternohyoid 



cervicalis 

Depresses and fixes hyoid 

bone 

Thyrohyoid 

8 

Oblique line on lamina of 


Greater horn and adjacent 

aspect of body of hyoid 

bone 

Fibers from anterior ramus 

of C1 carried along 

hypoglossal nerve [XII] 

Depresses hyoid bone, but 

when hyoid bone is fixed 

raises larynx 

Sternothyroid 

9 


manubrium of sternum 

Oblique line on lamina of 




cervicalis 

Draws larynx (thyroid 

cartilage) downward 

596

Tables 8 

3 

4 

5 

1 

8 

2 

9 

6 

7 

597


Branches of the external carotid artery 

Artery 


Ascending pharyngeal artery 


Parts supplied 

1 Thyrohyoid muscle, internal structures of the larynx, sternocleidomastoid and cricothyroid muscles, 

thyroid gland 

2 Pharyngeal constrictors and stylopharyngeus muscle, palate, tonsil, pharyngotympanic tube, meninges 

in posterior cranial fossa 

3 Muscles of the tongue, palatine tonsil, soft palate, epiglottis, floor of mouth, sublingual gland 

Facial artery 





4 All structures in the face from the inferior border of the mandible anterior to the masseter muscle to the 

medial corner of the eye, the soft palate, palatine tonsil, pharyngotympanic tube, submandibular gland 

5 Sternocleidomastoid muscle, meninges in posterior cranial fossa, mastoid cells, deep muscles of the 

back, posterior scalp 

6 Parotid gland and nearby muscles, external ear and scalp posterior to ear, middle and inner ear 

structures 

7 Parotid gland and duct, masseter muscle, lateral face, anterior part of external ear, temporalis muscle, 

parietal and temporal fossae 

8 External acoustic meatus, lateral and medial surface of tympanic membrane, temporomandibular joint, 

dura mater on lateral wall of skull and inner table of cranial bones, trigeminal ganglion and dura in 

vicinity, mylohyoid muscle, mandibular teeth, skin on chin, temporalis muscle, outer table of bones of 

skull in temporal fossa, structures in infratemporal fossa, maxillary sinus, upper teeth and gingivae, 

infra-orbital skin, palate, roof of pharynx, nasal cavity 

8 

7 

6 

4 

5 

3 

1 2 

598

Tables 8 

Subdivisions of the anterior triangle of the neck—a regional approach 

Subdivision 

Boundaries 

Contents 

Submental triangle 

(unpaired) 

1 

Mandibular symphysis; anterior belly of digastric 

muscle; body of hyoid bone 

Submental lymph nodes; tributaries forming the 

anterior jugular vein 

Submandibular triangle 

(paired) 

2 

Lower border of mandible; anterior belly of digastric 

muscle; posterior belly of digastric muscle 

Submandibular gland; submandibular lymph 

nodes; hypoglossal nerve [XII]; mylohyoid nerve; 

facial artery and vein 

Carotid triangle (paired) 

3 

Posterior belly of digastric muscle; superior belly of 

omohyoid muscle; anterior border of sternocleidomastoid 

muscle 

Tributaries to common facial vein; cervical branch 

of facial nerve [VII]; common carotid artery; 

external and internal carotid arteries; superior 

thyroid; ascending pharyngeal; lingual, facial, and 

occipital arteries; internal jugular vein; vagus [X], 

accessory [XI], and hypoglossal [XII] nerves; 

superior and inferior roots of ansa cervicalis; 

transverse cervical nerve 

Muscular triangle 

(paired) 

4 

Midline of neck; superior belly of omohyoid muscle; 

anterior border of sternocleidomastoid muscle 

Sternohyoid, omohyoid, sternohyoid, and thyrohyoid 

muscles; thyroid and parathyroid glands; 

pharynx 

2 

3 

1 

4 

599


Muscles associated with the posterior triangle of the neck 

Parentheses indicate possible involvement 



—Sternal head 

1 Upper part of anterior 

surface of manubrium of 

sternum 

Lateral one half of 

superior nuchal line 

Accessory nerve [XI] and 

branches from anterior 

rami of C2 to C3 (C4) 

Individually, will tilt head 

toward shoulder on same 

side rotating head to turn 

face to opposite side; 

acting together, draw 

head forward 

—Clavicular head 

2 Superior surface of medial 

one third of clavicle 

Lateral surface of mastoid 

process 

Trapezius 

3 Superior nuchal line; 

external occipital 

protuberance; 

ligamentum nuchae; 

spinous processes of 

vertebrae CVII to TXII 

Lateral one third of 

clavicle; acromion; spine 


Motor—accessory nerve 

[XI]; proprioception—C3 

and C4 

Assists in rotating the 

scapula during abduction 

of humerus above 

horizontal; 

upper fibers—elevate, 

middle fibers—adduct, 

lower fibers—depress 

scapula 


4 Lower half of ligamentum 

nuchae; spinous 

processes of vertebrae 

CVII to TIV 

Mastoid process, skull 

below lateral one third of 

superior nuchal line 

Posterior rami of middle 

cervical nerves 

Together, draw head 

backward; individually, 

draw and rotate head to 

one side (turn face to 

same side) 


5 Transverse processes of 

CI to CIV 

Upper part of medial 

border of scapula 

C3, C4; and dorsal 

scapular nerve (C4, C5) 

Elevates scapula 


6 Posterior tubercles of 


vertebrae CIV to CVI 

Upper surface of rib II 


Elevation of rib II 


7 Transverse processes of 

vertebrae CII to CVII 

Upper surface of rib I 

posterior to the groove for 

the subclavian artery 


Elevation of rib I 


8 Anterior tubercles of the 


vertebrae CIII to CVI 

Scalene tubercle and 

upper surface of rib I 


Elevation of rib I 

Omohyoid 

9 Superior border of 

scapula medial to 

scapular notch 

Inferior border of body of 

hyoid bone 

Ansa cervicalis; anterior 

rami of C1 to C3 

Depress the hyoid bone 

600

Tables 8 

3 

5 

1 

2 

4 

6 

7 

8 

9 

601


Prevertebral and lateral muscles 



anterior 

1 Anterior surface of lateral 

part of atlas and its 

transverse process 

Inferior surface of basilar 

part of occipital bone 

Branches from anterior rami 

of C1, C2 

Flexes head at 

atlanto-occipital joint 


lateralis 

2 

Superior surface of 

transverse process of atlas 

Inferior surface of jugular 

process of occipital bone 


of C1, C2 

Flexes head laterally to 

same side 

Longus colli 

—Superior 

oblique part 

3 

Anterior tubercles of 


vertebrae CIII to CV 

Tubercle of anterior arch of 

atlas 


of C2 to C6 

Flexes neck anteriorly 

and laterally and slight 

rotation to opposite side 

—Inferior 

oblique part 

4 

Anterior surface of bodies of 

vertebrae TI, TII, and maybe 

TIII 

Anterior tubercles of 


vertebrae CV and CVI 

—Vertical part 

5 


TI to TIII and CV to CVII 


vertebrae CII to CIV 


6 

Tendinous slips to 


vertebrae CIII to CVI 

Inferior surface of basilar 

part of occipital bone 


of C1 to C3 

Flexes the head 

2 

6 

1 

3 

5 

4 

602

Tables 8 

Constrictor muscles of the pharynx 

Muscle Posterior attachment Anterior attachment Innervation Function 


1 Pharyngeal raphe Pterygomandibular raphe 

and adjacent bone on the 

mandible and pterygoid 

hamulus 


Constriction of pharynx 


2 Pharyngeal raphe Upper margin of greater horn 

of hyoid bone and adjacent 

margins of lesser horn and 

stylohyoid ligament 




3 Pharyngeal raphe Cricoid cartilage, oblique line 

of thyroid cartilage, and a 

ligament that spans between 

these attachments and 

crosses the cricothyroid 

muscle 



1 

2 

3 

603


Longitudinal muscles of the pharynx 



1 

Medial side of base of 

styloid process 

Pharyngeal wall 


nerve [IX] 

Elevation of the pharynx 

Salpingopharyngeus 2 Inferior aspect of Pharyngeal wall Vagus nerve [X] Elevation of the pharynx 

pharyngeal end of 


Palatopharyngeus 3 Upper surface of Pharyngeal wall Vagus nerve [X] Elevation of the pharynx; 

palatine aponeurosis 

closure of the oropharyngeal 

isthmus 

Intrinsic muscles of the larynx 


Cricothyroid 

1 

Anterolateral aspect of 

arch of cricoid cartilage 

Oblique part—inferior horn 

of the thyroid cartilage; 

straight part—inferior 

margin of thyroid cartilage 


superior laryngeal 

nerve from the vagus 

nerve [X] 

Forward and downward 

rotation of the thyroid cartilage 

at the cricothyroid joint 

Posterior cricoarytenoid 

2 

Oval depression on 


lamina of cricoid 

cartilage 


muscular process of 


Recurrent laryngeal 

branch of the vagus 

nerve [X] 

Abduction and external 

rotation of the arytenoid 

cartilage. The posterior 

crico-arytenoid muscles are 

the primary abductors of the 

vocal folds. In other words, 

they are the primary openers 

of the rima glottidis. 

Lateral cricoarytenoid 

3 

Superior surface of arch 

of cricoid cartilage 

Anterior surface of 





nerve [X] 

Internal rotation of the 

arytenoid cartilage and 

adduction of vocal folds 


4 

Lateral border of 



Lateral border of posterior 

surface of opposite 




nerve [X] 

Adduction of arytenoid 

cartilages 


5 




Posterior surface of apex 

of adjacent arytenoid 

cartilage; extends into 

ary-epiglottic fold 



nerve [X] 

Sphincter of the laryngeal inlet 


6 

Thyroid angle and 

adjacent cricothyroid 

ligament 

Anterolateral surface of 

arytenoid cartilage; 

some fibers continue in 

ary-epiglottic folds to the 

lateral margin of the 

epiglottis 



nerve [X] 

Sphincter of vestibule and of 

laryngeal inlet 

Vocalis 

7 

Lateral surface of vocal 

process of arytenoid 

cartilage 

Vocal ligament and thyroid 

angle 



nerve [X] 

Adjusts tension in vocal folds 

604

Tables 8 

1 

2 3 

1 

4 

5 

6 

2 

7 

3 

605


Muscles in the floor of the oral cavity 


Mylohyoid 

1 

Mylohyoid line of mandible 

Median fibrous raphe and 

adjacent part of hyoid 

bone 


from the inferior 

alveolar branch of 


Geniohyoid 

2 

Inferior mental spines of 

mandible 

Body of hyoid bone 

C1 

Supports and elevates 

floor of oral cavity; 

depresses mandible 

when hyoid is fixed; 

elevates and pulls hyoid 

forward when mandible 

is fixed 

Muscles of the tongue 


Intrinsic 

Superior longitudinal 

(just deep to surface 

of tongue) 

1 Submucosal connective 

tissue at the back of the 

tongue and from the 

median septum of the 

tongue 

Muscle fibers pass 

forward and obliquely to 

submucosal connective 

tissue and mucosa on 

margins of tongue 


Shortens tongue; curls 

apex and sides of 

tongue 

Inferior longitudinal 

(between genioglossus 

and hyoglossus 

muscles) 

2 

Root of tongue (some 

fibers from hyoid) 

Apex of tongue 


Shortens tongue; 

uncurls apex and turns 

it downward 

Transverse 

3 

Median septum of the 

tongue 

Submucosal connective 

tissue on lateral margins 

of tongue 


Narrows and elongates 

tongue 

Vertical 

4 

Submucosal connective 

tissue on dorsum of 

tongue 

Connective tissue in 

more ventral regions of 

tongue 


Flattens and widens 

tongue 

Extrinsic 

Genioglossus 

5 Superior mental spines Body of hyoid; entire 

length of tongue 


Protrudes tongue; 

depresses center of 

tongue 

Hyoglossus 6 Greater horn and 

Lateral surface of tongue Hypoglossal nerve [XII] 

adjacent part of body of 

hyoid bone 

Styloglossus 7 Styloid process 

Lateral surface of tongue Hypoglossal nerve [XII] 

(anterolateral surface) 

Depresses tongue 

Elevates and retracts 

tongue 

Palatoglossus 

8 

Inferior surface of 

palatine aponeurosis 

Lateral margin of tongue 

Vagus nerve [X] (via 

pharyngeal branch to 

pharyngeal plexus) 

Depresses palate; 

moves palatoglossal 

fold toward midline; 

elevates back of the 

tongue 

606

Tables 8 

1 

2 

1 2 5 3 4 6 

7 

8 

607


Muscles of the soft palate 



1 Scaphoid fossa of sphenoid 

bone; fibrous part of 

pharyngotympanic tube; 

spine of sphenoid 

Palatine 

aponeurosis 


via the branch to medial 

pterygoid muscle 

Tenses the soft palate; opens 

the pharyngotympanic tube 


2 Petrous part of temporal 

bone anterior to opening for 

carotid canal 

Superior surface 

of palatine 

aponeurosis 

Vagus nerve [X] via 


pharyngeal plexus 

Only muscle to elevate the 

soft palate above the neutral 

position 


3 Superior surface of palatine 

aponeurosis 

Pharyngeal wall 




Depresses soft palate; moves 

palatopharyngeal arch toward 

midline; elevates pharynx 

Palatoglossus 

4 Inferior surface of palatine 

aponeurosis 

Lateral margin of 

tongue 




Depresses palate; moves 

palatoglossal arch toward 

midline; elevates back of the 

tongue 


5 Posterior nasal spine of hard 

palate 

Connective tissue 

of uvula 




Elevates and retracts uvula; 

thickens central region of soft 

palate 

1 

2 

5 

3 

4 

608

INDEX 

1 

A 

Abdomen 

arterial supply of viscera, 157 

coronal section, 156 

dermatomes, 205 

imaging, coronal section, 156 

innervation of, 199 

lymphatics, 198 

muscles of, 137–141 

quadrants and regions of, 135 

referred pain diagram, 202–203 

saggital section, 155 

surface anatomy, 134 

venous drainage of viscera, 180–181 

visceral motor innervation, 201 

visceral sensory innervation, 202–204 

Abdominal aorta, 137, 154, 157, 299 

branches of, 192 

imaging, 194–195 

positioning, 195 

Abdominal esophagus, 158 

Abdominal ostium, 243 

Abdominal viscera, 153 

Abdominal wall 

anterior, 151 

arteries of, 143 


innervation of, 144–145 

layers of, 136–137 

posterior, 183 

vessels of, 184 

superficial veins, 182 

transverse section, 137 

vasculature of, 142 

Abducent nerve, 498, 513, 584 

Abductor digiti minimi, 357–360, 444, 

446–447 

Abductor hallucis, 356–360 

Abductor pollicis brevis, 444, 446–447, 456 

Abductor pollicis longus, 9, 431, 435–436 

Abductor pollicis longus tendon, 440, 444–445 

Accessory ligament, 66 

Accessory nerve, 37, 498–499, 542, 585 

Acetabular foramen, 297 

Acetabular fossa, 294, 297–298 

Acetabular labrum, 298 

Acetabular ligament, transverse, 297–298 

Acetabular roof, 298 

Acetabulum, 212, 214, 220, 258, 294 

Achilles tendon, 5 

Acoustic meatus 

external, 520–521, 527 

internal, 485, 520–522, 524 

Acromioclavicular joint, 62, 385, 388 

Acromioclavicular ligament, 388, 397 

Acromion, of scapula, 4–7, 20, 36, 39, 385–386 

Adductor brevis, 8, 305, 309, 316 

Adductor canal, 310 

Adductor hallucis, 360 

Adductor hiatus, 309–310, 327 

Adductor longus, 8, 305–306, 309–310, 316 

Adductor magnus, 8–9, 301, 305, 307, 309, 

313–314, 316, 327 

Adductor magnus tendon, 309 

Adductor pollicis, 444, 446–447 

Adductor tubercle, 304 

Adrenal medulla, 204 

Adventitia of great vessels, 93 

Afferent lymphatic vessels, 12 

Ala of nose, 566–567 

Ala of sacrum, 212, 214, 220–221, 227, 

294–295 

Alar cartilage, 566–567 

Alveolar arch, 484, 572 

Alveolar artery 

anterior superior, 535, 576 

inferior, 507, 533, 576 

posterior superior, 535, 576 

Alveolar bone, 575 

Alveolar foramen, 527, 534 

Alveolar nerve 

anterior superior, 535, 569, 576–577 

inferior, 528, 531, 576 

middle superior, 535, 576–577 


Alveolar plexus, superior, 535, 576 

Alveolar process, 478 

Alveolar vein 

anterior superior, 576 

inferior, 533, 557, 576 

posterior superior, 576 

Ampulla, 524 

Anal aperture, 227–229, 255–256, 258 

Anal canal, 166, 222, 224, 230 


in sagittal plane, 3 

Anal columns, 231 

Anal crypt, 231 

Anal sinus, 231 

Anal sphincter 

external, 231 

cutaneous part, 222, 224, 230 

deep part, 222, 224, 230 

superficial, 222, 224, 230 

internal, 222, 224, 230–231 

Anal triangle, 255 

Anal valve, 231 

Anastomotic loops, 46 

Anatomical position, 2 

Anatomical snuffbox, 456 

Anconeus, 412, 435 

Angular artery, 506, 510 

Angular gyrus, 494 

Angular vein, 506, 510, 515 

Ankle, 7, 335 

bones, 293 

imaging, 338 

ligaments, 336–337 

Anococcygeal ligament, 228 

Anococcygeal nerves, 252 

Ansa cervicalis, 544–545, 579 

Antebrachial vein, 424, 457 

Anterior, as anatomical direction, 2 

Anterolateral central arteries, 500 

Anteromedial arteries, 500 

Anterosuperior margin of pubic symphysis, 221 

Antihelix, 520 

crura of, 520 

Antitragus, 520 

Anular ligament, 420, 422–423, 433, 444 

Anulus fibrosus, 32–33 

Aorta 

abdominal, 74, 137, 154, 157, 299, 312 




retroperitoneal, 186 

arch of, 10, 63, 74, 88, 99 

ascending, 10, 74, 89, 94, 102 

esophageal branches of, 118 

thoracic, 10, 74, 82, 88–89, 101, 107 

Aortic arch, 500 

Aortic hiatus, 73, 184–185 

Aortic nodes, 77, 198, 268–269 

Aorticorenal ganglion, 199, 201 

Aortic plexus, 199 

Aortic valve, 100–101 

auscultation point for, 106 

Apical foramen, 575 

Apical segment, of lung, 87 

Apicoposterior segment 

of bronchi, 87 

of lung, 87 

Appendicular artery, 157 

Appendix, 12, 166 

in coronal section of abdomen, 156 

orifice of, 168 

positions of, 168 

Arachnoid mater, 48–49 

Arachnoid trabeculae, 49 

Arcuate artery, 346, 355 

Arcuate eminence, 485 

Arcuate ligament 

lateral, 183, 185 

medial, 73, 183, 185 

median, 73, 183–184 

Arcuate line, 136, 140, 151 

Arcuate line of ilium, 216, 219–221, 294 

Areola, 4, 68–69 

Arms 

anterior compartment, 408–409, 431–434 

arteries, 410, 414, 434, 437 

bones, 385 

compartments of, 408 

imaging, 417, 421, 423, 439 

lymphatics, 415, 457 

muscle attachments, 407, 409, 413, 430 

muscles, 408–409, 412–413, 432–433, 435–436 

nerves, 410, 414, 418–419, 424, 434, 437, 

458–459 

posterior compartment, 412–414, 435–437 

surface anatomy, 384, 408, 412, 431, 435 

transverse section, 416–417, 438 

veins, 411, 457 

Arterial arcades, 165 

Arteria rectae, 170 

Arteries, 312. See also individual arteries 

to abdominal viscera, 157 

abdominal wall, 143 

arm 

anterior compartment, 410, 434 

posterior compartment, 414, 437 

to brain, 500, 502 

imaging, 501 

dural, 492 

eyes, 515 

foot, 354–355, 361–362 

gluteal, 302–303 

hand, 448–450, 454 

hip joint, 299 

infratemporal fossae, 533 

knee, 327 

leg, 342, 346 

nasal cavity, 569 

neck, 546–549 

parotid region, 507 

pelvic, 246 

pterygopalatine fossa, 535 

spleen, 160–161 

stomach, 160–161 

to teeth, 576 

temporal fossae, 533 

thigh, 311 

thoracic wall, 74 

thyroid gland, 564 

tongue, 579 

Articular cartilage, 326, 423 

Articular cavity, 326 

Articular disc, 529 


in elbow, 420 

vertebral, 24, 26 

609

INDEX 

Articularis genus, 305 

Articular process 

column of, 23 

inferior, 22 

superior, 295 

Articular tubercle, 484, 527, 529 

Articulus genus, 326 

Ary-epiglottic, 561 

Ary-epiglottic fold, 553, 555, 560 

Arytenoid 

oblique, 555, 561 

transverse, 552, 555, 561 

Arytenoid cartilage, 559–560 

Ascending aorta, 10 

Ascending colon, 152–153, 162, 166 


Asterion, 480 

Atlanto-axial joint, 23 

lateral, 23 

Atlanto-occipital joint, 499, 537 

Atrioventricular bundle, 100, 105 

Atrioventricular node, 105 

Atrioventricular ring, 100 

Atrium 

left, 94–95, 98 

right, 63, 94–97, 101, 103 

Auditory ossicles, 522 

Auricular artery, posterior, 506–507, 546 

Auricular muscle 

anterior, 505 


superior, 505 

Auricular nerve, great, 542, 544–545 

Auricular site for clavicle, 64 

Auricular vein, posterior, 506, 533, 539 

Auriculotemporal nerve, 503, 531–533 

Auscultation, triangle of, 36–37 

Auscultation points, 106 

Axial plane, 2–3 

Axilla, 68 

walls of, 396–397 

Axillary artery, 10, 69, 401–402, 410 

Axillary nerve, 13, 395, 403, 405, 414 

Axillary nodes, 12, 143 

apical, 69 

central, 69 

lateral, 69 

pectoral, 69 

subscapular, 69 

Axillary process, 68–69 

Axillary vein, 411 

Azygos vein, 11, 82, 119, 185 

B 

Back 

cutaneous nerves, 53 



deep, 40–41 

intermediate, 39 

suboccipital region, 43 

superficial, 37 

surface, 37 


surface anatomy of, 20, 36 

transverse section of thoracic region, 52 

Bare area, of liver, 173 

Basal segment, posterior 

of bronchi, 87 

of lung, 87 

Basilar artery, 500 

Basilar membrane, 524 

Basilic vein, 11, 384, 394–395, 411, 424, 457 

610 

Basivertebral vein, 47 

Benign prostatic hypertrophy, 236 

Biceps brachii, 8, 395, 408–409, 431 

Biceps brachii tendon, 8, 390, 431–432 

Biceps femoris, 9, 300, 305, 307, 313–314, 316, 

340, 343 

Biceps femoris tendon, 5, 292, 313 

Bicipital aponeurosis, 408, 424, 431 

Bifid spinous process, 24 

Bifurcate ligament, 336–337, 352 

Bile duct(s), 163, 173, 177–178 

Bladder, 147–148, 190, 222, 224, 237 

apex of, 232 


female, 233 



in situ, 230 

male, 232 

neck of, 232, 235 

positioning, female, 233 


surface projection 

female, 233 

male, 232 

transverse vesical fold, 237 

Body, surface of 

anterior view, 4 

posterior view, 5 

Bone marrow, 12 

Bones. See Skeleton; individual bones 

Bony orbit, 508 

Brachial artery, 10, 395, 400–402, 414, 424, 434 

Brachialis, 8, 408–409, 424, 431–432 

Brachial plexus, 13, 395, 403, 543 

cords of, 403–405 

Brachial veins, 11, 411 

Brachiocephalic nodes, 77 

Brachiocephalic trunk, 10, 82–83, 88, 107, 110, 

113, 500 

Brachiocephalic vein 

in axial plane, 3 

left, 75, 82, 88, 101, 110, 564 

right, 11, 82, 101, 110, 564–565 

Brachioradialis, 8, 408, 412, 424, 431, 435–436 

Brain, 494–498 

arterial supply, 500, 502 

imaging, 501 

commissures, 495 


lobes, 495 

Brainstem, 495 

Breast, 4, 68–69 

Bregma, 483 

Bronchial arteries, 82–83, 118 

Bronchial cartilage, 86 

Bronchial tree, 86 

Bronchomediastinal trunk, 77, 551 

Bronchopulmonary segments, 87 

Bronchus, 83 

inferior lobar, 86, 88 

left main, 86, 88–89 

middle lobar, 88 

right main, 89 

superior lobar, 86, 88 

Buccal artery, 507, 533 

Buccal nerve, 503, 531, 577 

Buccinator, 8, 504–505, 528, 554, 580 

Buccopharyngeal fascia, 538, 554, 580 

Buck’s fascia, 238, 240 

Bulbospongiosus, 222, 235, 240, 255–256 

Bulbo-urethral duct, 240 

Bulbo-urethral gland, 234, 240, 259 

Bundle branch, left, 105 

Bursae 

deep infrapatellar, 326 

glenohumeral joint, 392 

prepatellar, 326 

semimembranosus, 326 

subtendinous, 326 

suprapatellar, 326 

C 

Calcaneal artery 

lateral, 361–362 

medial, 361–362 

Calcaneal tendon, 5, 9, 292, 352 

Calcaneal tubercle, 330 

Calcaneal tuberosity, 292–293, 331, 356 

Calcaneocuboid joint, 333 

Calcaneocuboid ligament, 352 

Calcaneofibular ligament, 336–337, 352 

Calcaneometatarsal ligament, 356 

Calcaneonavicular ligament, 337 

Calcaneus, 7, 293, 330–332, 334 

Calcarine sulcus, 494–495 

Calyx 

major, 188 

minor, 188 

Camper’s layer, 136–137 

Canines, 573 

Capitate, 426, 428, 440 

Capitis superior, oblique, 41 

Capitulum, 6, 406 

Capsule 

of lens, 516 

of lymph node, 12 

Caput medusae, 182 

Cardia, of stomach, 158 

Cardiac branches (sympathetic), 110 

Cardiac impression, 82–83 

Cardiac nerves, sympathetic, 126, 545 

Cardiac notch, 82–83, 164 

Cardiac orifice, 169 

Cardiac plexus, 88, 126 

deep, 107 


Cardiac skeleton, 100 

Cardiac vein(s) 

anterior, 102 

great, 94–95, 99, 102 

middle, 95, 102 


small, 94, 102 

Cardial notch, of stomach, 158 

Caroticotympanic nerve, 522 

Carotid artery 

common, 506, 539, 546 


left, 10, 74, 88, 101, 110, 113, 500, 548–549, 565 

right, 74, 82, 88, 101, 109–110, 400, 500, 548, 

565 

external, 492, 500, 506–507, 533, 546 

left, 10, 500, 564 

right, 565 

internal, 500, 506, 546 

left, 10, 500, 564 

right, 500, 565 

Carotid canal, 484, 523 

Carotid nerve, internal, 535 

Carotid sheath, 538 

Carotid sinus, 500, 546 

Carotid triangle, 536 

Carpal arch, dorsal, 454 

Carpal artery, 437 

Carpal bones, 6, 385, 426 

Carpal ligament, 429

INDEX 

1 

Carpal tunnel, 440 

imaging, 441 

Carpometacarpal joint, 426, 429 

Cauda equina, 13, 33–34, 45, 48 

Caudal, as anatomical direction, 2 

Caudate lobe, of liver, 173, 175 

Caudate process, 175 

Caval opening, 73 

Cavernous nerve, 254 

Cavernous sinus, 493, 498, 500 

Cecum, 153, 166, 168–169 


Celiac ganglion, 199, 201 

Celiac nodes, 198, 268–269 

Celiac trunk, 10, 157 

branching of, 161 

distribution of, 160 

imaging, 161 

positioning of, 161 

Cement (dental), 575 

Central arteries, 516 

anterolateral, 500 

Central incisors, 573 

Central nodes, 415 

Central sulcus, 495 

Central tendon of diaphragm, 73, 185 

Central vein, 516 

Cephalic vein, 11, 384, 394–395, 411, 457 

Cerebellar artery 

anterior inferior, 500, 502 


posterior inferior, 502 

superior, 499–500, 502 

Cerebellar peduncles, 499 

Cerebellum, 50, 494–495, 499, 502 

Cerebral arterial circle, 500 


anterior, 500, 502 

middle, 500, 502 

posterior, 500, 502 

Cerebral hemispheres, blood supply, 502 

Cervical artery 

ascending, 46, 546, 548–549 

deep, 46, 548–549 

transverse, 37–38, 400, 402, 546, 548–549, 

564–565 

Cervical cardiac nerves, 88 

Cervical ganglia, 200, 544 

Cervical nerve(s), 44 

transverse, 542, 544 

Cervical nodes, 12 

anterior superficial, 550 

deep, 550–551 

posterior lateral, 550 


transverse, 550 

Cervical pleura, 80 

Cervical plexus, 13, 544–545 

Cervical vertebrae, 21–25, 386 

Cervical vertebral column, 50 

Cervix of uterus, 224, 241, 243, 245 

Cervix of vagina, 242 

Check ligament, medial, 509 

Chest wall 

anterior female, 62 

anterior male, 62 

Chiasmatic sulcus, 485 

Choanae, 567–568 

Chordae tendineae, 97, 99 

Chorda tympani nerve, 521, 523, 531–532, 579 

Choroid, 509, 516 

Choroidal artery 

anterior, 500 

posterior lateral, 500 

Choroid plexus, 495 

Ciliary artery 

anterior, 516 

long posterior, 515–516 

short posterior, 515–516 

Ciliary body, 516 

Ciliary ganglion, 513, 517 

Ciliary muscle, 516 

Ciliary nerves, 513 

long, 517 

short, 517 

Ciliary process, 516 

Cingulate gyrus, 494 

Circle of Willis, 500 

Circular muscle of esophagus, 554–555 

Circular muscle of rectum, 231 

Cisterna chyli, 12, 77, 119, 198 

Clavicle, 4, 6–7, 62–63, 71, 114, 385 

articular surface for, 387 

joints and ligaments, 388 

muscle attachments, 388 

Clavicopectoral triangle, 408 

Clavipectoral fascia, 70, 395 

Clinoid process 

anterior, 485 

middle, 485 


Clitoris 

crus of, 241, 262 

dorsal artery of, 246, 266 

dorsal nerve of, 267 

dorsal vein of, 266 

frenulum of, 257 

glans of, 224, 241, 256 

suspensory ligament of, 262 

Clivus, 485 

Cluneal nerves 

inferior, 53, 271, 302, 314–315 

medial, 53, 302 

middle, 271 

superior, 271 

C1 nerve, 499, 542, 544 

C2 nerve, 43, 53, 499, 542, 544 

C3 nerve, 43, 53, 542, 544 

C4 nerve, 542, 544 

C5 nerve, 34, 542, 544 

C6 nerve, 34, 542 

C7 nerve, 34, 542 

C8 nerve, 34, 542 

Coccygeal cornu, 294 

Coccygeal curvature, 21 

Coccygeal nerves, 44 

Coccygeal plexus, 252, 265, 271 

Coccygeus, 227, 241, 245 

Coccyx, 6–7, 21–22, 31, 212–216, 218–220, 

226–227, 229 

Cochlea, 520, 524 

Cochlear duct, 524 

Cochlear nerve, 520–521, 524 

Colic artery 

left, 157, 170 

middle, 157, 164, 170 

right, 157, 164, 170 

Colic flexure, 186 

in coronal plane, 3 

right, 166, 186 

Colic impression, on spleen, 159 

Colic vein 

left, 180–181 

middle, 181 

branch of, 180 

right, 181 

Collateral branches, 72 

Collateral ligaments, 351–352, 423, 429 

Collateral sulcus, 494 

Colliculus 

inferior, 495 

superior, 495 

Colon 

ascending, 152–153, 157, 162, 164, 166 


descending, 152, 157, 162, 166, 186 

haustra of, 166 

sigmoid, 147, 157, 166, 169, 222, 224, 230 



transverse, 153, 157, 163, 166 



Colonoscopy, 169 

Commissural ligament, 443 

Communicating artery 



Communicating vein, 539 

Compressor urethrae, 233, 259 

Conduction system of heart, 105 

Condylar process, 480, 572 

Condyle 

in elbow 

lateral, 7 

medial, 7 

in knee 

lateral, 293, 304 

medial, 293, 304 

occipital, 484 

Cone of light, 521 

Conjoint tendon, 138, 140, 148 

Conjunctiva, 509, 516 

Conjunctival fornix, 509 

Conjunctival sac, 509 

Conoid tubercle, 388 

Constrictor 

inferior, 540, 554–555, 563, 581 

middle, 528, 540, 554–555, 578, 581 

superior, 528–529, 554, 578, 581–582 

Conus arteriosus, 97 

Conus elasticus, 559 

Conus medullaris, 13, 45 

Coraco-acromial ligament, 388, 390 

Coracobrachialis, 8, 408–409 

Coracoclavicular ligament, 388 

Coracohumeral ligament, 390 

Coracoid process, 6, 62, 70–71, 385–386, 395 

Cornea, 509, 516 

Corniculate cartilage, 559 

Corniculate tubercle, 553, 560–561 

Cornua, 31 

Coronal plane, 2–3 

Coronal suture, 480, 483 

Coronary artery(ies), 103 

left, 94, 100, 102, 104 

anterior interventricular branch, 102–104 

circumflex branch, 102–104 

diagonal anterior interventricular branch, 103 

left-dominant system, 104 

right, 94, 100, 102–103 

marginal branch, 103 

posterior interventricular branch, 103 

sinu-atrial nodal branch, 103 

right-dominant system, 103 

variations, 103–104 

Coronary ligament, 172 

anterior, 173 


Coronary sinus, 94, 96, 99, 102 

Coronary sulcus, 94, 100–102 

Coronary vessels, 102 

611

INDEX 

Coronoid fossa, 406, 420, 423 

Coronoid process, 420, 480, 572 

Corpus albicans, 242 

Corpus callosum, 495 

Corpus cavernosum, 222, 234, 238, 240, 260 

Corpus luteum, 242 

Corpus spongiosum, 222, 234–235, 238, 240, 260 

Corrugator supercilii, 504 

Costal cartilage, 64–65, 72 

Costal facet 

inferior, 32 

superior, 32 


Costal groove, 72 

Costal margin, 4, 62, 125, 134, 394 

Costal pleura, 80, 114 

Costocervical trunk, 46, 546, 548–549 

left, 74 

right, 74 

Costochondral junction, 67 

Costoclavicular ligament, 388 

Costodiaphragmatic recess, 63, 79–81 

Costomediastinal recess, 79–81 

Costotransverse ligament, 32 

Costovertebral joint, 66 

Costovertebral ligament, radiate, 32 

Costoxiphoid ligament, 67 

Cranial, as anatomical direction, 2 

Cranial cavity, 485 

Cranial fossa, 485 

Cranial nerves, 498–499, 584–585 

Cremasteric muscle, 137–138, 140, 147–148, 234, 

238 

Cremasteric vessels, 148 

Cribriform plate, 485 

Crico-arytenoid 

lateral, 561 


Cricoid arch, 560, 563 

Cricoid cartilage, 552, 554, 558–561, 563 

Cricopharyngeus, 563, 565 

Cricothyroid, 541, 554, 563 

Cricothyroid articular capsule, 86 

Cricothyroid joint, 558 

Cricothyroid ligament, 536, 563 

Cricothyroid muscle, 561 

Cricotracheal ligament, 558 

Cricovocal membrane, 559 

Crista galli, 485, 566–568 

Crista terminalis, 96 

Crown, of tooth, 575 

Cruciate ligaments, 323–325 

Cruciform ligament, 444 

Crura of antihelix, 520 

Crus of clitoris, 241, 262 

Crus of diaphragm 

left, 119, 183, 185 

right, 73, 119, 183, 185 

Crus of penis, 240, 260 

Cubital fossa, 4, 384, 424 

Cubital nodes (supratrochlear or epitrochlear), 12, 

415, 457 

Cubital vein, median, 11, 411, 424, 457 

Cuboid, 330–332 

tuberosity of, 330 

Cuneiform 

intermediate, 330–332 

lateral, 330, 332 

medial, 330–332 

Cuneiform cartilage, 559 

Cuneiform tubercle, 553, 560–561 

Cuneocuboid ligament, 352 

Cuneonavicular ligaments, 352 

Cuneus, 495 

612 

Cupula, 80 

Cutaneous nerve(s), 17 

arm, 400, 414, 418–419, 424, 434, 458–459 

femoral lateral, 271 

femoral posterior, 252, 271 

lateral 

of thigh, 196–197 

T3-T11, 125 

T7-T11, 145 

lateral cutaneous branch of, 76 

legs, 347 

perforating, 252 

perineal, 271 

sural, 347 

thoracic, 125 

CI vertebra, 7, 21, 23–25, 499 

posterior ramus of, 43 

transverse process of, 43 

CII vertebra, 7, 21, 23–24, 50, 537 


spinous process of, 23, 40–41, 43 

transverse process of, 43 

CIII vertebra, 23, 537 


spinous process of, 23 

CIV vertebra, 23–24, 537 

CV vertebra, 22–24, 537 

CVI vertebra, 23, 537 

CVII vertebra, 6, 537 


Cisterna chyli, 268–269 

Cystic artery, 157, 161, 179 

Cystic duct, 163, 177–178 

D 

Dartos fascia, 234, 238 

Deciduous teeth, 573 

Decussation of pyramids, 499 

Deep artery 

of penis, 240 

of thigh, 10, 299, 312, 315–316 

Deep nodes, 12 

Deep palmar arch, 10 

Deep vein, of thigh, 11, 316 

Deltoid, 4–5, 8–9, 37, 394–395, 408, 412, 

540 

Deltoid fascia, 540 

Deltoid ligament of ankle, 336 

Deltoid tuberosity, 389 

Demifacet for articulation, vertebral, 22 

Dens, 24 

Denticulate ligament, 49 

Dentine, 575 

Depressor anguli oris, 504–505 

Depressor labii inferioris, 504–505 

Depressor septi, 504 

Dermatomes 

abdominal, 205 

abdominal wall, 145 

arms, 459 

in back, 53 

legs, 366–367 

perineal, 271 

thoracic, 125 

Descending colon, 152, 157, 166, 186 

Detrusor muscle, 230 

Diaphragm, 73, 79 

central tendon of, 73, 185 


costal, 73 

crus of 

left, 119, 183, 185 

right, 73, 119, 183, 185 

Diaphragm (Continued) 

features of, 73 

inferior view, 185 

left dome of, 63 

lumbar part, 73 


right dome of, 63 

Diaphragma sellae, 492, 498 

Diaphragmatic nodes, 77 

Diaphragmatic pleura, 80, 114 

Diaphragmatic surface of heart, 94 

Diencephalon, 495 

Digastric, 541 

Digital arteries 

dorsal, 346, 354–355, 456 

palmar, 448–450, 454 

plantar, 361–362 

Digital nerves 

dorsal, 455 

palmar, 448, 451, 455–456 

plantar, 361 

Digital phalanx, 330 

Digital veins 

dorsal, 457 

palmar, 457 

Digiti minimi, 356 

Dilator pupillae, 516 

Directions, anatomical, 2, 573 

Distal, as anatomical direction, 2, 573 

Dorsal hood, 363 

Dorsalis pedis artery, 10, 346, 354–355 

Dorsum 

of foot, 2, 4, 353 

of hand, 2, 452 

of nose, 566 

Dorsum sellae, 485, 534 

Ductus deferens, 147–149, 222, 231, 

237–238 

ampulla of, 234, 236–237, 240 

artery of, 239 

left, 234 


right, 234 

Duodenal cap, 162 

Duodenal papilla 

major, 163, 177 

minor, 177 

Duodenojejunal flexure, 163, 165, 177 

Duodenum, 157, 162–163 

ascending part, 162–163 


descending part, 162–163, 186 

imaging, 163, 169 

inferior part, 162–163 

in situ, 162 

superior part, 162–163 

suspensory muscle of, 163 


Dural arteries, 492 

Dural nerves, 492 

Dural partitions, 490 

Dural sheath, 509 

E 

Ear(s), 521 

imaging, 525 

internal, 520–521, 524 

left, 94, 97, 99, 101 

middle, 522 

right, 96–97 


Efferent ductules, 239 

Efferent lymphatic vessel, 12

INDEX 

1 

Ejaculatory duct, 234, 236 

beginning of, 237 

opening of, 235 

Elbow joint, 7, 385, 420–423 

Emissary veins, 533, 576 

Enamel (dental), 575 

Endocardium, 93 

Endometrium, 242 

Endoscopy, GI tract, 169 

Endothoracic fascia, 72 

Epicardium, 124 

Epicondyle 

in elbow 

lateral, 6–7, 386, 406, 420, 422, 432–433 

medial, 6–7, 386, 406, 420, 422, 432–433 

in knee 

lateral, 293, 304 

medial, 304 

Epicranial aponeurosis, 504–505 

Epididymis, 147 

appendix of, 238 

body of, 239 

head of, 149, 234, 239 

tail of, 239 

Epigastric artery 

inferior, 142–143, 147, 222, 224, 246–247 

left, 149 

right, 148 

superficial, 143, 238, 299, 312 

superior, 73, 142–143, 185 

right, 74 

Epigastric region, 135 

Epigastric vein 

inferior, 142, 147, 222, 224, 246–247 

left, 149 

right, 148 

superficial, 238, 364 

superior, 142 

right, 75 

Epigastric vessels, inferior, 141 

Epiglottis, 552, 555, 558–561, 580 

Epiphyseal plate, 298 

Episcleral space, 516 

Epitrochlear nodes, 415, 457 

Epitympanic recess, 521, 523 

Epoöphoron, 243 

Erectile muscles 

female, 262 

male, 260 

Erectile tissue 

female, 262–263 

male, 260–261 

Erector spinae, 9, 36, 40–42, 52, 137 

Esophageal artery, 157 

Esophageal branches, 160 

Esophageal hiatus, 73, 183 

Esophageal impression, on liver, 173 

Esophageal mucosa, 158 

Esophageal plexus, 116, 118 

Esophageal varices, 182 

Esophageal vein, 182 

Esophagus, 82, 88, 552–553 



Ethmoidal artery 



Ethmoidal bulla, 566–567 

Ethmoidal cells, 566 

Ethmoidal foramen 

anterior, 508 


Ethmoidal nerve, 492, 513, 569 

Ethmoid bone, 477, 485–486, 508, 534, 567 

Excretory duct of lacrimal gland, 510 

Extensor carpi radialis brevis, 412, 435 

Extensor carpi radialis brevis tendon, 440 

Extensor carpi radialis longus, 9, 412, 435–436 

Extensor carpi radialis longus tendon, 440 

Extensor carpi ulnaris, 412 

Extensor carpi ulnaris tendon, 440 

Extensor digiti minimi, 435 

Extensor digiti minimi tendon, 440 

Extensor digitorum, 9, 412, 435 

Extensor digitorum longus, 8, 343–345 

Extensor digitorum tendon, 440 

Extensor hallucis longus, 8, 345 

Extensor hood, 363 

Extensor indicis, 9, 436, 440 

Extensor pollicis brevis, 9, 435–436 

Extensor pollicis brevis tendon, 440 

Extensor pollicis longus, 9, 436 

Extensor pollicis longus tendon, 440 

Extensor retinaculum, 356, 435 

Extensor tendons, 292 

Extradural fat, 47 

Extraperitoneal fascia, 137, 141, 148 

Eyeball, 516 

Eyelash, 509 

Eyelid, 509–510 

inferior, 508 

superior, 508 

Eyes, 6 


movements, 514 

muscles, 512 

nerves, 513, 516 

sagittal section, 509 

vasculature, 515 

F 

Facial artery(ies), 10, 500, 506, 546 

transverse, 506–507, 510 

Facial canal, prominence of, 522 

Facial lymphatics, 506 

Facial muscles, 504–505 

Facial nerve, 499, 506–507, 511, 521–522, 532, 

585 

Facial nodes, 506, 550 

Facial surface anatomy, 508 

Facial vasculature, 506 

Facial vein, 11, 506, 515, 533, 539 

common, 539 

deep, 507, 557 

transverse, 506–507 

Falciform ligament, 141, 151, 164 

False ribs, 64 

Fat, extradural, 47 

Femoral artery, 142–143, 147–148, 238, 315–316, 

327 

lateral circumflex, 302, 312, 315 

ascending branch of, 299, 311–312 

descending branch of, 10, 299, 314–315 

transverse branch of, 10, 299, 311–312 

left, 192 

medial circumflex, 299, 302–303, 312, 314–315 

Femoral branch, 196 

Femoral cutaneous vein, 364 

Femoral head, ligament of, 297–298 

Femoral nerve, 13, 196, 303, 310–311 

intermediate cutaneous branch, 197 

medial cutaneous nerve from, 197 

muscular branches, 311 

Femoral nodes, 12 

Femoral sheath, 310 

Femoral triangle, 310 

Femoral vein, 11, 142–143, 147–148, 238, 316 

Femur, 6–7, 293, 295 

distal end, 304 

fovea of, 296 

greater trochanter of, 226 

head of, 296–298 

lesser trochanter of, 226 

neck of, 295–296, 298 

proximal, 296 

shaft of, 296 

Fibrocartilaginous joint, 67 

Fibroelastic membrane, 559 

Fibromuscular stroma, 232, 235 

Fibrous capsule, of kidney, 188 

Fibrous pericardium, 92–93, 124 

Fibrous ring, of aortic valve, 100 

Fibrous trigone, 100 

Fibula, 7, 329 

head of, 4, 6, 292–293 

proximal end, 304 

Fibular artery, 10, 342, 346 

circumflex, 327 

Fibular collateral ligament, 308, 320 

Fibularis brevis, 340, 343–345 

Fibularis brevis tendon, 9, 292, 336, 351 

Fibularis longus, 8–9, 300, 340, 343–345 

Fibularis longus tendon, 292, 336, 351 

Fibularis tertius, 345 

Fibular nerve, 13 

common, 314–315, 342, 346 

deep, 346–347, 354–355 

superficial, 346–347, 354 

Fibular retinaculum, 336 

Fibular trochlea, 330–331 

Fibular vein, posterior, 11 

Filiform papillae, 580 

Filum terminale, 44–45 

Fimbriae, 242 

Flank 

left, 135 

right, 135 

Flexor carpi radialis, 8, 408, 424, 431–432 

Flexor carpi radialis tendon, 431–432, 440, 444–445 

Flexor carpi ulnaris, 9, 412, 424, 431–432 

Flexor carpi ulnaris tendon, 432, 444–445 

Flexor digiti minimi, 444 

Flexor digiti minimi brevis, 357–360, 446–447 

Flexor digitorum brevis, 357–358 

Flexor digitorum longus, 9, 341, 357 

Flexor digitorum longus tendon, 351 

Flexor digitorum profundus, 8, 433, 436 

Flexor digitorum profundus tendons, 431–432, 

440, 444–445 

Flexor digitorum superficialis, 431–433 

Flexor digitorum superficialis tendons, 431–432, 

440, 444–446 

Flexor hallucis brevis, 357–360 

Flexor hallucis longus, 9, 341, 360 

Flexor hallucis longus tendon, 351 

Flexor pollicis brevis, 444, 446–447 

Flexor pollicis longus, 8, 431–433 

Flexor pollicis longus tendon, 431–432, 440, 

444–445 

Flexor retinaculum, 363, 431–432, 440, 444–445 

Floating ribs, 64 

Foliate papillae, 580 

Foot 

arteries, 354–355, 361–362 

bones of, 293, 330–333 

dorsum of, 2, 4, 353 

innervation, 354–355, 361–362 

joints, 333 

ligaments, 351–352 

median longitudinal arch, 331 


613

INDEX 

Foot (Continued) 

musculature, plantar, 357–360 

plantar surface of, 2 


transverse arch, 331 

Foramen lacerum, 484, 572 

Foramen magnum, 484–485, 500 

Foramen ovale, 484–485, 520, 527, 529, 534 

valve of, 98 

Foramen rotundum, 485, 534 

Foramen spinosum, 484–485, 527, 532–533 

Foramen transversum, 24 

Foregut, innervation of, 201–203 

Fornix, 495 

Fossa ovalis, 96 

limbus of, 96 

Fourchette, 257 

Fovea centralis, 516 

Fovea of femur, 296 

Free taenia, 168 

Frontal bone, 6, 477–478, 480, 483, 508, 527, 567 

Frontal crest, 485 

Frontalis, 8 

Frontal lobe, 495, 502 

Frontal nerve, 513 

Frontal operculum, 494 

Frontal process of maxilla, 478 

Frontal process of zygomatic bone, 526 

Frontal sinus, 552, 566–568 

Frontal suture, 477–478 

Frontobasal artery, lateral, 502 

Frontonasal duct, 567 

Fundiform ligament of penis, 238, 240, 260 

Fundus, of bladder, 232 

Fungiform papillae, 580 

G 

Gallbladder, 152–153, 163, 176–177 

body of, 173, 177 



neck of, 173, 177 


Ganglion impar, 200, 253–254 

Gastric artery(ies) 

left, 157, 160, 179 

right, 157, 160, 179 

short, 157, 160, 179 

Gastric canal, 158 

Gastric folds, 158 


of liver, 173 

of spleen, 159 

Gastric mucosa, 158 

Gastric vein 

left, 180–181 

right, 181 

short, 180–181 

Gastric vessels, short, 159 

Gastrocnemius, 5, 8–9, 292, 300, 305, 307, 340, 

343–344 

Gastroduodenal artery, 157, 160–161, 163, 179 


Gastroesophageal junction, 169 

Gastrointestinal tract, imaging, 169 

Gastro-omental artery 

left, 157, 159–160, 179 

right, 157, 160–161 

Gastro-omental vein 

left, 159, 179–181 

right, 181 

Gemellus inferior, 9, 301, 313 

Gemellus superior, 9, 301, 305, 313 

614 

Genicular artery 

descending, 312, 315, 327 

articular branch, 311–312, 315 

saphenous branch, 311–312, 315, 327 

inferior lateral, 312, 314–315, 327, 342 

inferior medial, 314–315, 327, 346 

medial genicular, 312 

superior lateral, 311–312, 314–315, 327, 342 

superior medial, 314–315, 327, 342 

Geniculate ganglion, 520, 522, 535 

Genioglossus, 552, 578, 580–581 

Geniohyoid, 552, 578, 580 

Genital branch, 196 

Genitofemoral nerve, 196–197 

femoral branch of, 148, 197, 303 

genital branch of, 147–149, 151, 238 

Gingiva, 575, 577 

Glabella, 478 

Glans of clitoris, 224, 241, 256 

Glans penis, 4, 20, 212, 234, 240, 250, 260 

Glenohumeral joint, 390–392, 399 

Glenohumeral ligament, 390 

Glenoid cavity, 387 

Glenoid labrum, 398 

Glossoepiglottic fold, 580 

Glossopharyngeal nerve, 498–499, 532, 543–544, 

556, 579, 585 

Gluteal artery 

inferior, 192, 246, 302–303, 312, 314–315 

superior, 192, 246, 248, 264, 299, 302, 312, 

314–315 

deep branch of, 302–303, 314–315 

superficial branch, 303, 314–315 

Gluteal fold, 5, 213, 215, 292 

Gluteal line 

inferior, 294 


Gluteal nerve 

inferior, 252, 254, 265, 302 

superior, 252–254, 265, 302–303, 315 

Gluteal region, 300–302 

Gluteal surface, 215, 220, 294 

Gluteal tuberosity, 296 

Gluteal vein 

inferior, 302 

superior, 247–248, 264, 302 

right, 193 

Gluteus maximus, 9, 255–256, 292, 301–302, 305, 

307, 316 

Gluteus medius, 9, 301–302, 305, 307 

Gluteus minimus, 301, 305 

Gonadal vein, left, 180 

Gonadal vessels, 190 

left, 184 

right, 184, 190 

Gracilis, 8–9, 301, 306–307, 309–310, 316, 340 

Gracilis tendon, 309 

Granular foveolae, 483 

Gray ramus communicans, 78, 253, 403 

Greater omentum, 152 

Greater trochanter, 6–7 

Greater tubercle, 6–7 

Great saphenous vein, 11 

Great vessels, adventitia of, 93 

Groin 

left, 135 

right, 135 

Gut tube, 137 

H 

Hair cells 

inner, 524 

outer, 524 

Hallucis longus, extensor, 8 

Hamate, 426, 428, 440 

Hamulus, 484 

Hands 

arteries, 448–450, 454 

bones, 385, 426, 428 

dorsal hoods, 453 

dorsum of, 452 

imaging, 427 

joints, 429 

ligaments, 429 



muscles, 446–447 

nerves, 448–449, 451, 455 

surface anatomy, 384, 443, 452 

tendon sheaths of, 444 

veins, 457 

Hard palate, 484, 552, 554, 581 

Haustra of colon, 166 

Head 

nerves, 586 


Head of fibula, 4 

Heart 

anterior surface of, 94 

base of, 95 

chambers of, 101 

computed tomography of, 94 

conduction system of, 105 


diaphragmatic surface of, 95 


visceral afferents, 127 

visceral motor, 126 

posterior view of, 94–95 

sounds, 106 

valves of, 101 

vasculature, 102–104 

visceral afferents from, 127 

Helicotrema, 524 

Helix, 520 

Hemi-azygos vein, 75, 82, 119, 185 

accessory, 47, 75, 83, 116 

Hemorrhoids, 182 

Hepatic artery 

common, 10, 157, 160–161, 179 

distribution of, 179 

left, 157, 179 

proper, 156–157, 160, 163 

left branch, 174 

right branch of, 174 

right, 157, 179 

Hepatic duct 

common, 163, 174, 177–178 


left, 177–178 

right, 177, 179 

Hepatic vein(s), 11, 160, 184, 193 

arrangement of, 174 


entering inferior vena cava, 174 


left, 174 

right, 174 

Hepatoduodenal ligament, 164 

Hepatopancreatic ampulla, 177 

Hernias, inguinal, 150 

direct, 150 

indirect, 150 

Hesselbach’s triangle, 150–151 

Hiatus semilunar, 567–568 

Hilum, 82, 110 

of spleen, 159

INDEX 

1 

Hindgut, innervation of, 201–203 

Hip joint, 7, 293, 297–298 

arterial supply, 299 


Hoods, dorsal, of hand, 453 

Horizontal fissure, 81–82 

Horizontal plane, 2 

Humeral artery 

anterior circumflex, 10, 395, 400–402, 410, 

414 

posterior circumflex, 395, 400–402, 410, 

414 

Humeral ligament, 390 

transverse, 396, 399 

Humeral nodes, 415 

Humeral nutrient artery, 402, 410, 414 

Humeral vein 

anterior circumflex, 411 

posterior circumflex, 411 

Humeroradial joint, 420 

Humero-ulnar joint, 420 

Humerus, 6–7, 36–37, 70, 385–386 

distal end, 406 

greater tubercle, 389 

head of, 389 

lesser tubercle, 389 

middle facet, 389 

neck of, 389 

proximal, 389 

superior facet, 389 

Hyaline cartilage, 32 

Hyaloid canal, 516 

Hymen, 257 

Hyoepiglottic ligament, 558–559, 580 

Hyoglossus, 554, 578–579 

Hyoid bone, 537, 552, 560–561 

Hypochondrium 

left, 135 

right, 135 

Hypogastric nerve, 272 

left, 253 

right, 199–200, 253–254 

Hypogastric plexus, 199, 254 

inferior, 201, 253–254, 272 

superior, 199–200, 254, 272 

Hypoglossal canal, 484–485 

Hypoglossal nerve, 498–499, 542, 545, 579, 585 

Hypophyseal arteries, 500 

Hypophyseal fossa, 485, 534, 567 

Hypothalamic sulcus, 495 

Hypothalamus, 495 

Hypothenar eminence, 384, 443, 446 

Hypothenar muscles, 8, 434 

I 

Ileal artery, 164, 170 

Ileal vein, 164, 180–181 

Ileocecal fold, 168 

Ileocecal fold flaps, 168 

Ileocecal junction, 168 


Ileocolic artery, 157, 170 


Ileocolic vein, 181 


Ileum, 164–166, 168 


imaging, 165 

Iliac artery 

common, 222, 224, 311–312 

left, 10, 251 


right, 184, 190, 192, 246–247 

Iliac artery (Continued) 

deep circumflex, 142–143, 149, 192, 246, 299, 

312 

external, 143, 148, 192, 222, 224, 246–247, 299, 

311 

left, 10, 190 


right, 264 

internal, 192, 198, 222, 224, 246, 264, 299 

anterior trunk, 264 

left, 10, 190 

right, 190, 248 

superficial circumflex, 142–143, 299, 312 

Iliac crest, 5, 7, 20, 36, 39–41, 212–216, 220, 

226–227, 295 

tubercle of, 294 

Iliac fossa, 196, 212, 214, 216, 294–295 

Iliac nodes, 12 

common, 198, 268–269 

external, 198, 268–270 

internal, 198, 268–270 

Iliac spine 

anterior inferior, 220–221, 295 

anterior superior, 4, 134, 218, 220–221, 

226–227, 293, 295 

posterior inferior, 294 

posterior superior, 7, 40, 220, 226–227, 

293–295 

Iliac tuberosity, 294 

Iliacus, 147, 151, 164, 183, 222, 224, 231, 305–306, 

308, 310–311 

Iliacus fossa, 310 

Iliac vein(s) 

common, 193, 222, 224, 251 

left, 11, 190 

right, 247 

deep circumflex, 142, 149 

external, 11, 148, 182, 222, 224, 246–247 

left, 184, 190, 193 

right, 190, 193, 264 

internal, 11, 222, 224, 247, 251, 264 

anterior trunk, 264 

left, 248 

right, 193 

superficial circumflex, 142, 364 

Iliococcygeus, 227–229, 231, 245, 258, 260, 

262 

Iliocostalis, 40, 71 

Iliocostalis cervicis, 40, 71 

Iliocostalis lumborum, 40 

Iliocostalis thoracis, 40 

Iliofemoral ligament, 226, 299 

Iliohypogastric nerve, 53, 144, 196, 303 

anterior cutaneous branch of, 145, 197 

lateral cutaneous branch of, 144, 197 

Ilioinguinal nerve, 144, 148, 196–197, 238, 271, 

303 

Iliolumbar artery, 192, 246, 248 

iliac branch of, 192 

Iliolumbar ligament, 218 

Iliolumbar vein, 248 

Iliopsoas, 8, 305, 308, 316 

Iliopubic eminence, 216 

Iliotibial tract, 8–9, 292, 300, 306, 316, 327 

Ilium, 6, 294 

arcuate line, 216, 220–221 

gluteal surface of, 213, 220 

Imaging, of spinal cord, 50–51 

Incisive canal, 567 

Incisive fossa, 484, 572, 581 

Incisive nerve, 531, 576 

Incisors, 573 

Incus, 521–523 

ligament of, 523 

Inferior, as anatomical direction, 2 

Infraclavicular nodes, 415 

Infraglenoid tubercle, 387 

Infraglottic space, 560 

Infrahyoid muscles, 538 

Infraorbital artery, 507, 510, 535, 576 

Infraorbital fissure, 534 

Infraorbital foramen, 478, 480, 508, 534 

Infraorbital groove, 508 

Infraorbital nerve, 510, 535, 569, 576 

Infraorbital vein, 507, 515, 576 

Infrapatellar bursa, 326 

Infraspinatus muscle, 9, 37–39, 52, 398–399, 412 

Infraspinous fossa, 387 

Infratemporal bones, 527 

Infratemporal crest, 527 

Infratemporal fossae, 526, 528–529 

arteries, 533 

nerves, 532 

veins, 533 

Infratrochlear artery, 510 

Infratrochlear nerve, 503, 510, 513 

Infratrochlear vein, 510 

Inguinal canal, 146, 148–149, 234 

Inguinal hernias, 150 

direct, 150 

indirect, 150 

Inguinal ligament, 138, 143, 148, 151, 183, 212, 

214, 219, 238, 308, 310 

surface, 134 

Inguinal nodes, 12 

deep, 268–269 

inferior superficial, 268–269 


superolateral superficial, 269 

superomedial superficial, 268–269 

Inguinal region 

female, 146–147 

male, 146–147 

Inguinal ring 

deep, 146, 148–149, 151 

superficial, 138, 146, 148, 234, 238 

Inguinal triangle, 151 

right, 150 

Inion, 482 

Insula, 502 

Interarytenoid fold, 560 

Interarytenoid notch, 553, 555, 560 

Intercarpal ligament, 426, 429 

Interchondral joint, 67 

Interclavicular ligament, 388 

Intercondylar fossa, 326 

Intercondylar line, 304 

Intercostal artery(ies), 72, 78, 143 

anterior, 74 

collateral branch of, 74 

left supreme, 75, 118 


collateral branch of, 74 

left, 46 

right, 46 

right supreme, 74 

supreme, 548–549 

Intercostal membrane, external, 70, 72 

Intercostal muscle, 68, 72 

external, 8–9, 52, 71–72, 396 

innermost, 52, 72 

internal, 8, 52, 71–72 

Intercostal nerve(s), 13, 32, 72, 76, 78, 119, 202 

anterior cutaneous branch of, 76, 125, 145 


sixth thoracic, 69 

small collateral branch of, 76 

thoracic, 69 

615

INDEX 

Intercostal nodes, 77 

Intercostal space, 64 

Intercostal vein, 72 

left superior, 75 

posterior, 47 

Intercostal vessels, 142 

Intercostobrachial nerve, 403–404, 418 

Intercuneiform ligaments, 352 

Intergluteal cleft, 5, 20, 213, 215 

Intermaxillary suture, 572 

Intermediate nerve, 520–522 

Interossei muscles, 360 

Interosseous artery 

anterior, 434 

common, 410, 434, 437 


recurrent, 414, 434, 437 

Interosseous membrane, 326, 433 

Interosseous nerve, 434, 437 

Interphalangeal joints, 333, 429, 453 

Intersphincteric groove, 231 

Interspinalis cervicis, 43 

Interspinous ligament, 35 

Interthalamic adhesion, 495 

Intertragic notch, 520 

Intertransversarius, 41 

Intertrochanteric crest, 293, 295–296, 299 

Intertrochanteric line, 293, 295–296 

Intertubercular plane, 135 

Intertubercular sulcus, 386, 389 

Interureteric fold, 233 

Interventricular septum, 124 

Interventricular sulcus, anterior, 94, 101 

Interventricular vein, anterior, 102 

Interventricular vessels, anterior, 99 

Intervertebral disc, 21, 24, 32 

LV-SI, 218–219 

Intervertebral disc problems, 33–34 

Intervertebral disc protrusion, 33 

Intervertebral foramen, 26, 32, 48 

Intervertebral vein, 47 

Intestinal nodes, 12 

Intestinal trunk, 198 

Intestine 

large, 12, 166 

imaging, 167 

surface projections, 166 

small, 152–153, 186 


lymph nodes in, 12 


Intra-articular ligament, 66 

Intraparietal sulcus, 494 

Investing layer, 538 

Iridocorneal angle, 516 

Iris, 508–509 

Ischial ramus, 294–295 

Ischial spine, 7, 212–221, 227–229, 293, 

295 

Ischial tuberosity, 7, 213, 215, 220, 229, 255–256, 

258, 294, 297, 299, 301 

Ischio-anal fossa, 151, 231 

Ischiocavernosus, 240, 255–256, 260 

Ischiococcygeus, 227–229 

Ischiofemoral ligament, 226, 299 

Ischiopubic arch, 259 

Ischiopubic ramus, 220, 229 

Ischium, 6, 294 

ramus of, 212–216, 220 

J 

Jejunal artery, 164, 170 

Jejunal vein, 164, 180–181 

616 

Jejunum, 164–165, 186 


imaging, 165 

Joint(s) 

acromioclavicular, 62, 385, 388 

ankle, 7, 335 

atlanto-axial, 23 

atlanto-occipital, 499, 537 

calcaneocuboid, 333 

carpometacarpal, 426, 429 

clavicular, 388 

costovertebral, 66 

cricothyroid, 558 

elbow, 7, 385, 420–423 

fibrocartilaginous, 67 

foot, 333 

in hand, 429 

hip, 7, 293, 297–298 

humeroradial, 420 

humero-ulnar, 420 

interchondral, 67 

interphalangeal, 333, 429, 453 

knee, 7, 318–319, 322–325 

lumbosacral, 218 

manubriosternal, 64, 67 

metacarpophalangeal, 429 

metatarsophalangeal, 292, 333 

midcarpal, 426 

radio-ulnar, 420, 425 

sacro-iliac, 6, 31, 214, 219, 221, 227, 

294–295 

shoulder, 7, 385–386 

spinal, 35–36 

sternoclavicular, 62, 386, 388 

sternocostal, 64, 66–67 

subtalar, 333 

synovial, 66–67 

talocalcaneonavicular, 333 

tarsometatarsal, 333 

temporomandibular, 528–530 

tibiofibular, 318 

wrist, 7, 385, 425–427 

xiphisternal, 64, 67 

zygapophyseal, 24, 28–29 

Jugular foramen, 484–485 

Jugular notch, 62, 64, 522 

Jugular trunk, 77, 551 

Jugular tubercle, 485 

Jugular vein 


external, 11, 506, 533, 539, 557 

internal, 11, 75, 77, 82, 110, 506–507, 533, 539, 

557 

left, 101, 109–110, 564 

right, 101, 109, 395, 565 

Jugulodigastric node, 506, 550–551 

Jugulo-omohyoid node, 506, 550–551 

K 

Kidney(s) 

anterior surface structures, 186 

fascia surrounding, 186 

fat surrounding, 186 

fibrous capsule of, 188 

gross structure of, 188 

hilum of, 188 

imaging, 189 

inferior pole of, 188 

lateral border, 188 

left, 160, 163, 186 

medial border, 188 

posterior surface structures, 186 

retroperitoneal position of, 186 

Kidney(s) (Continued) 

right, 160, 163 

anterior surface, 188 

internal structure, 188 


superior pole of, 188 

surface projection of, 186 


visceral sensory diagram, 204–205 

Knee 

arteries, 327 

bones of, 293 

bursa, 326 

capsule, 326–327 

ligaments of, 320–321 

surface, 327 

Knee joint, 7, 293, 318–319, 322–325 

L 

Labial artery 

inferior, 506 


superior, 506 

Labial vein 

inferior, 506 


superior, 506 

Labium majus, 224, 257 

Labium minus, 224, 256–257 

Labyrinthine artery, 500 

Lacrimal apparatus, 510 

Lacrimal artery, 510, 515 

Lacrimal bone, 477, 480, 486, 508, 534 

Lacrimal canaliculi, 510 

Lacrimal caruncle, 510 

Lacrimal crest, 510 

Lacrimal fold, 510 

Lacrimal gland, 510–511 

Lacrimal lake, 508 

Lacrimal nerve, 503, 510–511, 513, 535 

Lacrimal papilla, 510 

Lacrimal punctum, 510 

Lacrimal sac, 509 

Lacrimal sac fossa, 512 

Lactiferous ducts, 68 

Lactiferous sinuses, 68 

Lacunar ligament, 148, 151, 217 

Lambda, 483 

Lambdoid suture, 480, 482–483 

Large intestine, 12, 166–167 

imaging, 167 


Laryngeal artery 

inferior, 565 

superior, 546 

Laryngeal cartilage, 559 

Laryngeal cavity, 560 

Laryngeal inlet, 552–553, 560 

Laryngeal nerve, 562 

external, 562 

internal, 562 

left recurrent, 107, 110, 556, 562, 564 

right recurrent, 88, 107, 110, 556, 562, 564 

superior, 543, 556, 562 

Laryngeal saccule, 560 

Laryngeal vein, superior, 557 

Laryngeal ventricle, 560 

Laryngopharynx, 552–553 

Larynx, 4 

external features, 558 

muscles, 561 

nerves, 562 

surface anatomy, 558, 563

INDEX 

1 

Lateral, as anatomical direction, 2 

Lateral ligament, 528 

Latissimus dorsi, 5, 36–38, 137–138, 394–395, 408 

Leg 

arteries, 342, 346 

bones, 293 

dermatomes, 366–367 

imaging, 349 



menisci, 322–323 


muscles, 340–341, 343–345 

nerves, 342, 346–347 

superficial muscles, 340 


transverse section, 348–349 

veins, 364 

Lens, 509, 516 

Lesser curvature, of stomach, 158 

Lesser omentum, 154, 164 

Lesser trochanter, 6–7 

Levator anguli oris, 504–505 

Levator ani, 151, 222, 224, 227–229, 231, 235, 

259–260 

Levatores costarum, 41 

Levator labii superioris, 504–505 

Levator labii superioris alaeque nasi, 504–505 

Levator palpebrae superioris, 509, 512 

Levator palpebrae superioris tendon, 504, 

509–510 

Levator scapulae, 9, 36–39, 540–541 

Levator veli palatini, 522–523, 529, 554–555, 

581 

Ligamenta flava, 35 

Ligamentum arteriosum, 92, 94, 97, 109–110, 

116 

Ligamentum nuchae, 20, 35–36, 39–40 

Ligamentum venosum, fissure for, 173 

Limbus, of fossa ovalis, 96 

Linea alba, 134, 136–137, 141 

Linea aspera, 293, 295–296 

Lingual artery, 500, 507, 546, 579, 582 

Lingual glands, 582 

Lingual gyrus, 494–495 

Lingual nerve, 528, 532, 576–577, 580, 582 

Lingual tonsil, 12, 552, 580 

Lingual vein 

deep, 579, 582 

dorsal, 579 

Lingula, 82–83, 529, 572 

Lip, lower, 580 

Liver, 172, 186 

anterior medial segment V, 175 

anterior surface, 172 

caudate lobe of, 173, 175 



inferior border of, 164, 172 

lateral segment II, 175 

lateral segment III, 175 

left lobe of, 152–153, 164 

location of, 172 

medial segment IV, 175 

posterior lateral segment VII, 175 

posterior surface of, 173 

quadrate lobe, 173 

right anterior lateral segment VI, 175 

right lobe of, 152–153, 172 

round ligament of, 151, 153, 164, 172 

segments of, 175 


vessels of, 174 

visceral surface of, 173 

L1 nerve, 43, 53, 144, 148 

anterior ramus, 303 


L2 nerve, anterior ramus, 303 

L3 nerve, anterior ramus, 303 

L4 nerve, 34 

L5 nerve, 34 

Lobule, 520 

Longissimus, 40, 71 

Longissimus capitis, 40, 43 

Longissimus cervicis, 40 

Longissimus thoracis, 40 

Longitudinal axis, 2 

Longitudinal ligament, anterior, 218–219 

Longitudinal muscle 

of esophagus, 554–555 

of rectum, 231 

of tongue, 580 

Longus capitis, 540–541 

Longus colli, 541 

Lumbar arteries, 192 

Lumbar ganglia, 200 

Lumbar meninges, 48 

Lumbar nerves, 34, 44 

Lumbar node, 198, 268–269 

Lumbar plexus, 13, 196 

cutaneous distribution, 197 

Lumbar triangle, 37 

Lumbar trunk 

left, 198 

right, 198 

Lumbar vein, ascending, 119 

Lumbar vertebrae, 21–22, 27–30 

Lumbosacral articular surface, 294 

Lumbosacral joint, 218 

Lumbosacral ligament, 218 

Lumbosacral trunk, 196, 252–253, 303 

Lumbricals, 357–358, 445–446 

Lunate, 426, 428 

Lunate surface, 297 

Lung(s) 


left, 79, 83 

right, 79, 82 

Lunule, 100 

LI vertebra, 21 

LIII vertebra, 22 

LIV vertebra, 29–30, 33 

LV vertebra, 21, 27–28, 31, 219, 222, 224, 294 

Lymphatic drainage, 551 

Lymphatic duct, right, 12 

Lymphatic system, 12 

in abdomen, 198 

in abdominal wall, 143 

in arms, 415, 457 

facial, 506 

in hands, 457 

in legs, 365 

in neck, 550–551 

in perineum, 270 

female, 269 

male, 268 

in thoracic wall, 77 

Lymphatic trunk(s), 69 

termination of, 77 

M 

Malleolar artery 

anterior lateral, 346, 354–355 

anterior medial, 346, 354–355 

Malleolar fold 



Malleolus, 4, 6–7 

lateral, 4, 6–7, 292–293, 343 

Malleus, 521–522 

ligament of, 521, 523 

Mammary gland, 68 

Mammillary body, 494, 499 

Mammography, 69 

Mandible, 6, 477, 527, 552 

alveolar part, 478 

angle of, 7, 480, 572 

bay of, 478 


lateral view, 572 

medial view, 572 


ramus of, 478, 480, 572 

superior view, 572 

Mandibular canal, 528–529, 580 

Mandibular fossa, 484, 527 

Mandibular nerve, 492, 498–499, 503, 511, 517, 

531–532, 535, 576 

Mandibular node, 550 

Mandibular symphysis, 572 

Manubriosternal joint, 64, 67 

Manubrium of sternum, 3, 6, 62, 64, 386, 538 

Marginal artery, 157, 170 

Marginal sulcus, 495 

Marginal vessels, 102 

Masseter, 8, 504–505, 526, 528, 540 

Masseteric artery, 533 

Masseteric fascia, 540 

Masseteric nerve, 531 

Mastoid air cells, 522–523 

Mastoid antrum, 523 

Mastoid nodes, 506, 550 

Mastoid notch, 482, 484 

Mastoid process, 7, 43, 480, 482, 484, 523, 527, 

540 

Maxilla, 6, 477–478, 527 

Maxilla bone, 480, 487 

Maxillary artery, 492, 500, 507, 533, 535, 546, 576 

Maxillary nerve, 492, 498, 503, 511, 517, 531–532, 

535, 556, 576 

Maxillary sinus(es), 535, 566, 573 

Maxillary vein, 507, 533, 539, 557, 576 

Medial, as anatomical direction, 2 

Median nerve, 13, 395, 403, 405, 410, 424, 434, 

455 

Mediastinal pleura, 93, 108–109 

Mediastinal plexus, 110 

Mediastinum, 79, 91, 116 

anterior, 91 

imaging, 113, 115, 117, 120, 121–122 

inferior, 91 

middle, 91 

posterior, 91, 118–119 

subdivisions of, 91 

superior, 91, 108 

imaging, 111 

nerves of, 110 

trachea in, 112 

transverse section at TIV, 121 

transverse section at TV, 122 


transverse section at TIII, 120 

Medulla 

adrenal, 204 

renal, 188 

Medulla oblongata, 494–495 

Medullary arteries, segmental, 46 

Medullary sinus, 12 

Medullary vellum 

inferior, 495 

superior, 495 

617

INDEX 

Meningeal artery, 492 

middle, 507, 531, 533 

recurrent, 515 

Meningeal nerve, 531–532 

Meninges, 48–49, 490 

Meniscus (menisci), 324–325 

lateral, 320, 323 

medial, 323 

Mental artery, 507, 533 

Mental foramen, 478, 480, 527, 533, 

572–573 

Mentalis, 504–505 

Mental nerve, 503, 531, 576 

Mental protuberance, 478 

Mental spines, 572, 578 

Mental tubercle, 478 

Mental vein, 533 

Mesenteric artery(ies), 170 

inferior, 10, 157, 160, 170, 184, 190, 

192 

superior, 10, 157, 160, 170, 179–180, 184, 190, 

192, 268 

branching, 171 



Mesenteric ganglion 

inferior, 201 

superior, 199 

Mesenteric nodes 

inferior, 198, 268–269 

superior, 198, 268–269 

Mesenteric vein 

inferior, 11, 179–181 


superior, 11, 160, 179–181, 186 


Mesenteric vessels, superior, 164 

Mesentery, 156, 164 

Mesial, as anatomical direction, 573 

Meso-appendix, 168 

Mesocolon, transverse, 186 

Mesosalpinx, 243 

Metacarpal artery 

dorsal, 454 

palmar, 448–450 

Metacarpal ligaments, 429, 443, 445 

Metacarpals, 6, 385, 426, 428 

Metacarpal vein, dorsal, 456–457 

Metacarpophalangeal joint, 429 

Metatarsal arteries 

deep, 346 

dorsal, 355 

plantar, 355, 362 

Metatarsal ligaments, 351–352, 356 

Metatarsals, 6–7, 293, 330–332 

Metatarsophalangeal joint(s), 333 

of great toe, 292 

Metencephalon, 494 

Midbrain, 499 

Midcarpal joint, 426 

Middle lobe of lung, 82 

Midgut, innervation of, 201–203 

Midline raphe, 235, 240, 260 

Mitral valve, 98–99, 101 

auscultation position for, 106 

Modiolus, 524 

lamina of, 524 

Molars, 573 

Mons pubis, 256 

Mucosa 

esophageal, 158 

gastric, 158 

of rectum, 231 

tracheal, 86 

618 

Mucosal linings of naval cavity, 568 

Multifidus, 41, 43 

Muscle(s). See also individual muscles 

abdomen, 137–141 

arm, 408–409, 412–413, 432–433, 

435–436 

back, 36–43 

eye, 512 

facial, 504–505 

foot, plantar, 357–360 


hand, 446–447 

infratemporal fossa, 528–529 

knee, 327 

larynx, 561 

leg, 340–341, 343–345 

neck, 540–541 

oral cavity, 578 

palate, 581 

pharynx, 554–555 

rotator cuff, 398–399 

thigh, 305 


Muscle attachments 

clavicle, 388 

foot, 350 

hand, 442 

lower leg, 339 

shoulder, 407 

skull, 488–489 

thigh, 305, 308–309, 313 

upper limb, 392–393, 409, 413, 430 

Muscular triangle, 536 

Musculi pectinati, 96 

Musculocutaneous nerve, 13, 395, 403–405, 410, 

424 

Musculofascial pouch, 234 

Musculophrenic artery, 74, 142–143 

Musculophrenic vein, right, 75 

Musculus uvulae, 555, 581 

Mylohyoid, 531–532, 540–541, 578, 580 

Mylohyoid line, 572 

Myometrium, 242 

N 

Naris, 566 

Nasal aperture, posterior, 484 

Nasal artery 

dorsal, 515 

external, 569 

lateral, 506, 569 

Nasal bone, 477–478, 480, 483, 566–567 

Nasal cartilage, accessory, 566 

Nasal cavity, 510, 552, 566 

bones, 567 


mucosal linings, 568 

nerves, 569 

Nasal concha 

inferior, 477–478, 566–568 

middle, 510, 566–568 

superior, 566–568 

Nasal crest, 478 

Nasalis, 504–505 

Nasal meatus 

inferior, 510, 568 

middle, 568 

superior, 568 

Nasal nerve(s), 535 

external, 503 

posterior inferior lateral, 569 

posterior superior lateral, 569 

Nasal septum, 555, 568 

Nasal spine 

anterior, 478 


Nasal vein, 569 

lateral, 506, 569 

Nasal vestibule, 568 

Nasion, 478 

Nasociliary nerve, 513, 517 

Nasofrontal vein, 515 

Nasolacrimal duct, 510, 567–568 

Nasopalatine nerve, 569, 577, 581 

Nasopharynx, 552–553 

Navicular, 330–332 

Navicular fossa, 234, 240 

Neck. See also Larynx; Pharynx 

arteries, 546–549 

bones, 537 

compartments, 538 

fascia, 538 

imaging, 547, 549, 553 

lymphatics, 550–551 

muscles, 540–541, 554–555 

nerves, 542–544 

surface anatomy, 476, 536 

veins, 539 

Nerve(s), 13–17. See also individual nerves 


abdominal wall, 144–145 

arm, 424 

anterior compartment, 410, 434 

cutaneous, 418–419, 458–459 

posterior compartment, 414, 437 

in back, cutaneous, 53 

bladder, 274 

cardiac, 107 

cranial, 498–499, 584–585 

cutaneous, 17 

arm, 400, 414, 418–419, 424, 434, 458–459 

femoral lateral, 271 

femoral posterior, 252, 271 

lateral 

of thigh, 196–197 

T7-T11, 145 


legs, 347 

perforating, 252 

perineal, 271 

sural, 347 

dural, 492 

eyes, 513, 516 

facial, 506 

foot, 354–355, 361–362 


gums, 577 

hand, 448–449, 451, 455 

head, 586 


lacrimal gland, 511 

larynx, 562 

leg, 342, 346–347 


neck, 542–544 

oral cavity, 583 

parasympathetic, 15 

pelvic, 252–253 

perineal, 267 

pharynx, 556 

pterygopalatine fossa, 535 

reproductive system 

female, 273 

male, 272 

spinal, 44–45, 47 

anterior rami of, 252 

nomenclature of, 44

INDEX 

1 

Nerve(s) (Continued) 

sympathetic, 14 

teeth, 576–577 

thigh, 311, 314 


tongue, 579 

Nipple, 4, 68 

Nodule, in aortic valve, 100 

Nose, 566. See also entries at Nasal 

Nuchal line 


superior, 37, 40, 482, 484 

Nucleus pulposus, 32 

herniation of, 33–34 

Nucleus solitarius, 127 

O 

Oblique fissure, 81–83, 85 

Oblique line, 478 

Oblique muscles (in eyes) 



Oblique muscles (in trunk) 

external, 8–9, 37–39, 42, 71, 136–138, 141–142, 

148, 238 

internal, 8–9, 42, 136–138, 141–142, 148, 

238 

Oblique vein, of left atrium, 102 

Obliquus capitis inferior, 41, 43 

Obliquus capitis superior, 41, 43 

Obturator artery, 234, 246, 248, 251, 264, 297, 

299, 312 

posterior branch, 299 

Obturator canal, 153, 219, 226–228 

Obturator externus, 8, 305, 311 

Obturator foramen, 196, 212–216, 218, 220–221, 

232, 258, 295 

Obturator internus, 9, 151, 226, 228–229, 240, 

258, 262, 301, 305 

fascia covering, 227 

tendon of, 226, 258 

Obturator membrane, 151, 153, 217, 219, 297 

Obturator nerve, 13, 196–197, 252, 254, 265, 271, 

303, 311, 316 

cutaneous branch, 197 

muscular branches, 311 

posterior branch, 311 

Obturator node, 270 

Obturator vein, 234, 247–248, 251, 264 

Obtuse margin, 94, 101 

Occipital artery, 43, 492, 500, 506–507, 546, 579 

Occipital bone, 7, 40, 477, 480, 482–483, 485 

Occipital condyles, 484, 537 

Occipital crest 

external, 482 

internal, 485 

Occipitalis, 9 

Occipital lobe, 495 

Occipital nerve 

greater, 43, 53 

lesser, 542, 544–545 

third, 43, 53 

Occipital nodes, 506, 550 

Occipital pole, 494 

Occipital protuberance, external, 7, 35, 37, 482, 

484–485 

Occipital vein, 506–507, 539 

Occipitofrontalis, 504–505, 540 

Occipitomastoid suture, 480, 482 

Occipitotemporal gyri, 494 

Oculomotor nerve, 498–499, 513, 517, 584 

Odontoid process, 24 

Olecranon, 5, 7, 384–385, 406, 412, 420, 423 

Olecranon fossa, 406, 423 

Olfactory bulb, 494, 498–499, 569 

Olfactory nerves, 498, 569, 584 

Olfactory tract, 494, 499 

Olive, 499 

Omental appendices, 166 

Omental bursa, 154 

Omental foramen, 164 

Omentum 

greater, 152 

lesser, 154 

Omohyoid, 540–541 

Ophthalmic artery, 500 

inferior, 533 

Ophthalmic nerve, 492, 498–499, 503, 511, 513, 

517, 531–532, 535 

Ophthalmic vein(s), 507 


superior, 515 

Opponens digiti minimi, 360, 444, 446–447 

Opponens pollicis, 446–447, 456 

Optic canal, 485, 508, 534 

Optic chiasm, 495, 498–499 

Optic disc, 516 

Optic nerve, 498–499, 509, 513, 516, 584 

Oral, as anatomical direction, 573 

Oral cavity, 552 

bones, 572–573, 575 

imaging, 574 

muscles, 578 

nerves, 583 

root of, 582 

Oral vestibule, 580 

Ora serrata, 516 

Orbicularis oculi, 8, 504–505, 509 

Orbicularis oris, 8, 504–505, 580 

Orbital fissure 


superior, 478, 485, 508, 534 

Orbital gyri, 494 

Orbital nerves, 535 

Orbital septum, 504, 509–510 

Orbital sulci, 494 

Oropharyngeal isthmus, 582 

Oropharynx, 552–553, 582 

Otic ganglion, 532 

Oval window, 521–522, 524 

Ovarian artery, 10, 249 

left, 147 

right, 192 

Ovarian plexus, 199 

Ovarian vein(s), 11, 193, 249 

left, 147 

Ovarian vessels, 242 

Ovary(ies), 147, 224, 241–243 

structure of, 242 

suspensory ligament, 224, 242 

P 

Palate, 581–582 

hard, 484, 552, 554, 581 

soft, 552–553, 568, 581 

Palatine aponeurosis, 581–582 

Palatine artery, 535 

greater, 569, 581–582 

lesser, 535, 581–582 

Palatine bone, 477, 508, 527, 534 

Palatine canal, 534 

Palatine foramen, 484, 572, 581 

Palatine glands, 552, 582 

Palatine nerve, 535 

greater, 577, 581–582 

lesser, 535, 581–582 

Palatine rugae, 581 

Palatine tonsil, 12, 552, 580–582 

Palatine vein, greater, 569 

Palatoglossal arch, 552, 580, 582 

Palatoglossus, 578–582 

Palatopharyngeal arch, 552, 582 

Palatopharyngeus, 554–555, 580–582 

Palatovaginal canal, 534, 567 

Palmar aponeurosis, 432, 443 

Palmar arch 

deep, 10 


Palmar interosseous, 446–447 

Palmaris brevis, 443 

Palmaris longus, 8, 408, 424, 432 

Palmaris longus tendon, 431–432, 440, 

443 

Palmar ligament, 429, 445–446 

Palmar surface, of hand, 2 

Palpable bone 



Palpebral fissure, 510 

Palpebral ligament, 504, 510 

Pampiniform plexus, 149, 238–239 

Pancreas, 154, 176–177, 186 

anterior surface of, 176 


fundus of, 177 


imaging, 176 




tail of, 176 

uncinate process, 176 


Pancreatic artery 

dorsal, 179 

inferior, 179 

Pancreatic duct 

accessory, 177 

main, 177 

Pancreatic notch, 176 

Pancreaticoduodenal artery 

anterior inferior, 160, 179 

anterior superior, 160 



posterior inferior, 160, 179 



Pancreaticoduodenal vein, 181 

Papillary muscle 

anterior, 97, 99, 105 

posterior, 97, 99, 105 

septal, 97 

Paracentral lobule, 495 

Paracolic gutter 

left, 153 

right, 153 

Parahippocampal gyrus, 494 

Paranasal sinuses, 566 

Paranephric fat, 186 

Parasternal nodes, 69, 77 

Parasympathetic nerves, 15 

in face, 532 

Parathyroid gland 



Paratracheal nodes, 551 

Para-urethral gland, opening of duct, 257 

Parietal bone, 7, 477, 480, 482–483, 485 

Parietal foramen, 483 

619

INDEX 

Parietal lobe, 495 

Parietal peritoneum, 136–137, 141, 148, 222 

Parietal pleura, 72, 79–81, 124 

cervical, 92 

Parietomastoid suture, 480 

Parieto-occipital sulcus, 495 

Parotid duct, 504–505 

Parotid fascia, 540 

Parotid gland, 504, 506–507, 528 

Parotid nodes, 506, 550 

Parotid region 

arteries, 507 

veins, 507 

Pars flaccida, 521 

Pars opercularis, 494 

Pars orbitalis, 494 

Pars triangularis, 494 

Patella, 4, 6, 292, 304 

Patellar ligament, 308, 320, 327 

Patellar retinaculum, 327 

Patellar surface, 304 

Pecten pubis, 212, 216, 221, 294 

Pectineal line, 212, 216, 221, 294 

Pectineus, 8, 305–306, 309–310, 316 

nerve to, 311 

Pectoral fascia, 68 

Pectoralis major, 3–4, 8, 68–70, 408, 540 

abdominal part, 138, 394 


clavicular part, 394 

sternocostal part, 394 

Pectoralis major fascia, 540 

Pectoralis minor, 8, 68, 70–71, 395 

Pectoral nerve 

lateral, 70, 395, 403–404 

medial, 70, 395, 403–404 

Pectoral nodes, 415 

Pectoral region, 71, 394 

Pedicle, 22, 30, 45 

Pelvic bone, 293–294 

Pelvic brim, 221 

Pelvic cavity 

female, 277–283 

floor, 227–229 


lateral wall, 226 

male, 230, 275–277 

Pelvic fascia, 245 

Pelvic girdle, 216 

imaging, 217 

orientation of, 221 

Pelvic inlet, 220 

Pelvic nerve plexus, 253 

Pelvic outlet, 220 

Pelvis 

arterial supply of, 246 

articulated, 212–214, 295 


female, 269 

male, 268 

renal, 186, 188 

subpubic angle in 

female, 214 

male, 212 

surface anatomy 

female, 214–215 

male, 212–213 

venous drainage of, 247 

viscera 

female, 224 

imaging, 225 

male, 222 

imaging, 223 


620 

Penis, 4, 240 

bulb of, 222, 234–235, 260 

artery of, 266 

vein of, 266 

crus of, 240, 260 

deep artery of, 240, 266 

dorsal arteries of, 238, 245, 250, 264, 

266 

dorsal nerve of, 265, 267, 271 

dorsal veins of, 238, 245, 250, 264 


fundiform ligament of, 238, 240, 260 

glans, 20, 212, 234, 240, 250, 260 

prepuce of, 240 

skin of, 240 

suspensory ligament of, 222, 240, 260 

venous drainage, 250 

Pericardiacophrenic artery, 92, 114 

left, 108 

Pericardiacophrenic vein, 92, 114 

left, 109 

right, 109 

Pericardiacophrenic vessels, 92 

Pericardial cavity, 93 

Pericardial layers, 93 

Pericardial reflections, 94–95 

Pericardial sac, 93 

Pericardial sinus 

oblique, 93, 124 


Pericardium, 92, 109–110 

fibrous, 92–93, 124 

serous, 93, 124 

Peridontium, 575 

Perineal artery, 264 

transverse branches, 266 

Perineal branches, 314 

Perineal membrane, 151, 230, 232–233, 235, 240, 

259 

Perineal muscle 

deep transverse, 230, 234, 259 

superficial transverse, 240, 255–256, 262 

Perineal nerve, 265, 267, 271 

posterior labial branch, 267 

posterior scrotal branch, 267 

Perineal pouch 

deep, 151, 230, 232–233, 235, 241, 259 

motor branches, 267 

muscles of, 259 


Perineal vein, 247, 264 

transverse branches, 266 

Perinephric fat, 186 

Perineum 

borders of, 258 

ceiling of, 258 


female, 258 


female, 269 

male, 268 

male, 222, 258 

imaging, 223 

nerves of, 267 

surface anatomy 

female, 214–215, 256–257 

male, 212–213, 254, 257 


Periorbita, 509 

Periosteum, 509 

Peritoneal cavity, 137 

arrangement of abdominal contents, 155 

greater and lesser sacs of, 154 

imaging, 155 

Peritoneum, 224, 237 

parietal, 136–137, 141, 148, 222 

visceral, 222 

Pes anserinus, 305 

Petrosal nerve 

deep, 535 

greater, 511, 520, 535 

lesser, 522 

Petrosal sinus, 493 

Petrotympanic fissure, 527, 532 

Peyer’s patch, 12 

Phalanges (foot), 6, 293, 330–332 

Phalanges (hand), 6, 385, 426, 428 

Pharyngeal artery, 492, 535 

ascending, 546 

Pharyngeal constrictor(s), 552 

superior, 505 

Pharyngeal nerve, 535 

Pharyngeal raphe, 554 

Pharyngeal recess, 552, 568 

Pharyngeal tonsil, 12, 552–553, 568 

Pharyngeal tubercle, 484, 554 

Pharyngobasilar fascia, 554–555, 581 

Pharyngo-epiglottic fold, 555 

Pharyngotympanic tube, 521–523, 552–555, 568, 

572 

Pharynx, 552–553 

innervation, 556 

muscles, 554–555 

veins, 556 

Phrenic artery 

inferior 

left, 185, 192 

recurrent branch of, 192 

right, 192 

interior, 190 

right, 185 

inferior, 185 

Phrenic nerve(s), 13, 202, 403, 543–544 

left, 92, 185 

right, 92, 114 

Phrenic vein(s), inferior 

left, 193 

right, 193 

Pia arterial plexus, 46 

Pia mater, 48–49 

Pillar cells, 524 

Pineal gland, 495, 499 

Piriform aperture, 478 

Piriform fossa, 553 

Piriformis, 9, 226–229, 241, 258, 301–303, 305 

Piriform recess, 560 

Pisiform, 426, 428, 440 

Pisohamate ligament, 429, 432, 445 

Pisometacarpal ligament, 429, 432, 445 

Pituitary gland, 494–495, 498 

Planes, anatomical, 2 

Plantar aponeurosis, 356 

Plantar artery 

deep, 346, 354, 362 


medial, 361–362 

Plantar calcaneonavicular ligament, 351 

Plantar cuboideonavicular ligament, 351 

Plantar cuneonavicular ligament, 351 

Plantar interossei, 359–360 

Plantaris, 9, 305, 307, 340–341 

Plantar ligament, 336, 351 

long, 351–352 

Plantar lymph vessels, 365 

Plantar metatarsal ligaments, 351 

Plantar nerve 

lateral, 347, 361–362 

medial, 347, 361–362

INDEX 

1 

Plantar surface, of foot, 2 

Plantar tarsometatarsal ligaments, 351 

Platysma, 504–505, 540, 580 

Pleural cavity(ies), 79 

left, 79 

Pleural recesses, surface projections of, 81 

Pons, 494–495, 499 

Pontine arteries, 500 

Popliteal artery, 10, 314–315, 327, 342, 346 

Popliteal fossa, 5, 328 

Popliteal ligament, 320 

Popliteal nodes, 12, 365 

Popliteal vein, 11, 342, 365 

Popliteus, 9, 305, 341 

Popliteus tendon, 320 

Porta hepatis, 173 

Portal hypertension, venous enlargement in, 182 

Portal triad, 174 

Portal vein, 11, 162, 174, 179 


formation of, 181 

left branch, 174 

right branch, 174 

Portosystemic anastomoses, 182 

Postcentral gyrus, 494 

Postcentral sulcus, 494 

Posterior, as anatomical direction, 2 

Posterior cord, 405 

Posterior segment, of lung, 87 

Posterior triangle, 536 

Posterolateral arteries, 500 

Posteromedial arteries, 500 

Postremal chamber, 516 

Preaortic nodes, 198, 268–269 

Preauricular nodes, 506, 550 

Precuneus, 495 

Prelaryngeal nodes, 551 

Premolars, 573 

Pre-occipital notch, 494 

Prepatellar bursa, 326 

Prepuce of penis, 240 

Presymphyseal node, 268 

Pretracheal layer, 538 

Pretracheal nodes, 551 

Pretracheal space, 538 

Prevertebral layer of neck, 538 

Prevertebral plexus, 14, 201, 253 

Princeps pollicis artery, 449–450 

Procerus, 504–505 

Processus vaginalis, ligamentous remnant of, 239 

Profunda brachii artery, 10, 395, 400–402, 410, 

414 

Pronator quadratus, 8, 431–433, 444 

Pronator teres, 8, 408, 424, 431–432, 436 

Prostate, 151, 222, 230, 232, 235–237 

anterior region, 236 

capsule of, 232, 235 

central zone, 236 

glandular elements, 235 


peripheral zone, 236 

transitional zone, 236 

venous drainage, 250 

Prostatic ducts, openings of, 235 

Prostatic fascia, 245 

Prostatic plexus, 245, 250, 254 

Prostatic sinus, 235 

Prostatic urethra, 222, 232, 235 

Prostatic utricle, 235 

Proximal, as anatomical direction, 2 

Psoas major, 29, 42, 137, 147, 151, 183, 185–186, 

268, 311 

Psoas minor, 183, 268 

Pterion, 480 

Pterygoid(s), 554 

lateral, 528–530, 532 

medial, 528–529, 532 

Pterygoid artery, 533 

Pterygoid canal, 484, 534–535 

Pterygoid fossa, 484 

Pterygoid hamulus, 527, 529, 534, 567, 572 

Pterygoid plate, 534 

medial, 554 

Pterygoid plexus of veins, 507, 515, 557, 576 

Pterygoid process, 572 

Pterygomandibular raphe, 505, 529, 554, 580, 582 

Pterygomaxillary fissure, 527 

Pterygopalatine canal, 534 

Pterygopalatine fossa, 527, 534–535, 556 

Pterygopalatine ganglion, 511, 535 

Pubic crest, 216, 219–221, 294 

Pubic ligament, inferior, 229, 258 

Pubic ramus 

inferior, 212–214, 216, 220–221, 231, 294–295, 

297 

superior, 212–216, 294–295 

Pubic region, 135 

Pubic symphysis, 4, 6, 134, 139, 212–216, 218– 

222, 224, 226–229, 295 

anterosuperior margin, 221 

Pubic tubercle, 134, 137, 212, 214, 216, 218, 

220–221, 226, 232, 294–295, 297 

Pubic vessels, 148 

Pubis, 6 


Pubocervical ligament, 245 

Pubococcygeus, 227–229, 231, 245, 258, 260, 262 

Pubofemoral ligament, 299 

Puboprostatic ligament, 232, 245 

Puborectalis, 227, 229, 231, 258, 260, 262 

Pubovesical ligament, 233 

Pudendal artery, 264 

external 

deep, 238, 299, 312 

superficial, 142–143, 299 

internal, 246, 251, 264, 266, 299, 303 

left, 245 

right, 250 

Pudendal canal, 231 

Pudendal nerve, 246, 252–254, 265, 267, 274, 302 

Pudendal vein, 264 

external, 364 

internal, 182, 247, 251, 264, 266 

left, 245 

right, 250 

superficial external, 142, 238 

Pulmonary artery(ies), 82–83, 98–99 

left, 88–89, 94–95, 109–110 

right, 88, 94–95 

branches of, 101, 109–110 

Pulmonary ligament, 80, 82–83 

Pulmonary plexus, 88 

posterior, 88 

Pulmonary trunk, 63, 74, 89 

Pulmonary valve, 97, 101 

Pulmonary vein(s), 82–83, 88, 98–99, 109 

left, 88, 94–95, 101, 109–110 

right, 93–95, 101, 110, 114 

Pulmonary vessels, 88 


Pulp cavity, 575 

Pupil, 508 

Pyloric antrum, 158, 162 


Pyloric canal, 158 

Pyloric orifice, 158, 177 

Pyloric sphincter, 169 

Pylorus, 158, 169 

Pyramid, 499 

Pyramidal eminence, 521 

Pyramidalis, 140, 149 

Pyramid in renal medulla, 188 

Q 

Quadrangular membrane, 559 

Quadrangular space, 414 

Quadrate lobe, of liver, 173 

Quadratus femoris, 9, 301–302, 305, 313 

Quadratus lumborum, 41–42, 137, 183–186, 192 

Quadratus plantae, 358, 360 

Quadriceps femoris, 305, 308, 343 

Quadriceps femoris tendon, 320, 344 

R 

Radial artery, 10, 410, 424, 434, 437, 456 

Radial collateral artery, 401–402, 410, 414, 434 

Radial collateral ligament, 422 

Radial fossa, 406 

Radial groove, 389 

Radialis indicis artery, 448–450, 456 

Radial nerve, 13, 395, 400, 405, 410, 414, 424, 437 

Radial notch, 406, 420, 425 

Radial recurrent artery, 410, 414, 434 

Radial recurrent vein, 411 

Radial styloid process, 425 

Radial tuberosity, 420, 425 

Radial vein, 11 

Radiate ligament, 66 

Radicular artery 

anterior, 46 

posterior, 46 

Radicular vein 

anterior, 47 

posterior, 47 

Radiocarpal ligament, 429 

Radio-ulnar joint, 420, 425 

Radio-ulnar ligament, 429 

Radius, 6–7, 385, 425, 433 

borders of, 425 




Rami communicantes, 32, 45 

Ramus of ischium, 212–216, 220 

Ramus of mandible, 478, 480, 572 

Rectal artery 

inferior, 246, 250–251, 266 

middle, 192, 246, 248, 251 

superior, 157, 170, 190, 248, 251 

Rectal fascia, 231 

Rectal nerve, inferior, 265, 267 

cutaneous branches, 271 

Rectal neurovascular bundle, 251 

Rectal vein 

inferior, 247, 250–251, 266 

middle, 182, 247–248, 250–251 

superior, 181, 248, 251 

Rectal venous plexus 

external, 231, 251 

internal, 231, 251 

perimuscular, 251 

Rectal vessels, superior, 186 

Recto-uterine pouch, 224, 243, 245 

Rectovaginal septum, 245 

Rectovesical pouch, 222 

Rectovesical septum, 245 

Rectum, 147, 157, 166, 169, 222, 231 

circular muscle of, 231 


inferior transverse fold, 231 

621

INDEX 

Rectum (Continued) 

in situ, 230 

longitudinal muscle, 231 

middle transverse fold of, 231 

mucosa of, 231 



surface projection, female, 231 


Rectus 

inferior, 509, 512, 514 

lateral, 509, 512, 514 

medial, 509, 512, 514 

superior, 509, 512, 514 

Rectus abdominis, 8, 136–137, 140–142, 149 

position of tendinous intersection, 134 

Rectus capitis anterior, 541 

Rectus capitis lateralis, 541 

Rectus capitis posterior major, 41, 43 

Rectus capitis posterior minor, 41, 43 

Rectus femoris, 8, 300, 305–306, 308, 310, 316 

Rectus sheath, 8 

anterior wall, 136, 141 

organization of, 141 

posterior wall, 136–137, 141, 151 

Referred pain diagram, abdominal, 202–203 

Regional vertebrae, 22 

Renal artery 

left, 10, 190, 192, 268 

right, 190, 192 

Renal column, 188 

Renal cortex, 188 

Renal impression 

on liver, 173 

on spleen, 159 

Renal medulla, 188 

Renal papilla, 188 

Renal pelvis, 186, 188 

Renal sinus, 188 

Renal vasculature, 190–191 

Renal vein(s), 193 

left, 147, 190 

right, 190 

Reproductive system 

female, 241–244 


male, 234–240 


Rete testes, 239 

Reticular fiber, 12 

Retina, 509, 516 

Retinal artery, central, 515 

Retromandibular vein, 506–507, 533, 539, 557, 

576 

Retromolar fossa, 572 

Retromolar triangle, 572 

Retropharyngeal space, 538 

Retropubic space, 222 

Rhomboid major, 9, 36–38, 52, 398, 412 

Rhomboid minor, 9, 36–38, 398 

Rib(s) 

I, 6, 63–65 

II, 64–65 

III, 64 

IV, 64 

V, 64–65 

VI, 64 

VII, 64 

VIII, 64 

IX, 64 

X, 64 

XI, 63–64, 73, 186 

XII, 63–65, 73, 185–186 

anatomy of, 65 

622 

Rib(s) (Continued) 

articulations of, 66–67 

demifacets for articulation of, 22 

false, 64 

floating, 64 

head of, 65 


placement of, 63 

true, 64 

Rima glottidis, 560 

Rima vestibuli, 560 

Risorius, 504–505, 540 

Root canal, 575 

Rotator cuff muscles, 398–399 

Rotatores thoracis, 41 

Round window, 521–522, 524 

S 

Saccule, 524, 561 

Sacral artery(ies) 

lateral, 46, 192, 246, 248 

median, 184, 192, 246, 251 

Sacral canal, 216, 220, 228, 294 

Sacral cornua, 31, 215, 294 

Sacral crest 

lateral, 31 

median, 31 

Sacral curvature, 21 

Sacral dimple, at posterior iliac spine, 5, 20, 215 

Sacral foramina, 31 


posterior, 213, 215, 226, 294–295 

Sacral ganglia, 200 

Sacral hiatus, 213, 215, 294–295 

Sacral meninges, 48 

Sacral nerve(s), 34, 44, 196 

Sacral node 


median, 270 

middle, 268 

Sacral plexus, 13, 252 

Sacral promontory, 3, 221 

Sacral vein 


median, 193, 247, 251 

Sacrococcygeal ligaments, 218–219, 228 

Sacro-iliac joint, 6, 31, 214, 219–221, 227, 294–295 

Sacro-iliac ligament 

anterior, 218–219 

interosseous, 219 

posterior, 218–219, 226 

Sacrospinous ligament, 218–219, 226, 228, 301, 

303 

Sacrotuberous ligament, 219–220, 226, 228–229, 

258–260, 262, 301, 303 

Sacrum, 6–7, 21–22, 31, 212–216, 218, 220–221, 

226–228, 293–294 

ala of, 212, 220–221, 227, 295 

articular surface of, 219 

Sagittal axis, 2 

Sagittal plane, 2–3 

Sagittal sinus, 493 

Sagittal suture, 482–483 

Salivary glands, 578 

Salpingopharyngeal fold, 552–553 

Salpingopharyngeus, 554–555, 581 

Saphenous hiatus, 364–365 

Saphenous nerve, 13, 310–311, 346, 354 

from femoral nerve, 197 

Saphenous vein 

accessory, 364 

great, 11, 268–269, 310, 316, 364 

small, 11, 364 

Sartorius, 8, 292, 300, 305–308, 310, 316, 340, 344 

nerve to, 311 

Sartorius tendon, 308 

Scala tympani, 524 

Scala vestibuli, 524 

Scalene(s), 8, 538 

anterior, 394, 540–541 

middle, 394–395, 541 

posterior, 394, 540–541 

Scalp, 490 

Scaphoid, 426, 428, 456 

Scaphoid fossa, 484, 572 

Scapula, 6–7, 385–386 

acromion of, 5–6, 20, 36, 39 


in axial plane, 3, 70 

inferior angle of, 5, 7, 20, 36–37, 63, 387 

lateral border of, 387 


medial border of, 5, 387 


spine of, 5, 20, 36–38, 385 

superior angle of, 7, 36, 63, 387 

in transverse section of thoracic vertebral 

column, 52 

Scapular artery 

circumflex, 401–402, 410, 414 

dorsal, 37, 400, 548 

Scapular ligament, 386, 400 

Scapular nerve, dorsal, 37–38, 403–405 

Scarpa’s layer, 136–137, 238 

Sciatic foramen 

greater, 218–219, 226, 253, 301 

lesser, 218–219, 226 

Sciatic nerve, 13, 252, 302–303, 314–316 

muscular branch, 314–315 

Sciatic notch 

greater, 213, 215, 294 

lesser, 216 

Sclera, 508–509, 516 

Scleral venous sinus, 516 

Scrotal artery, posterior, 250, 264, 266 

Scrotal nerve, posterior, 265 

Scrotal raphe, 257 

Scrotal vein, posterior, 250, 264, 266 

Scrotum, 4, 212, 238 

septum of, 238 

skin of, 238 

Secretory lobules, of mammary gland, 68 

Segmental muscles, 41 

Semicircular canal 

anterior, 520–521, 524 

lateral, 520–521, 524 

posterior, 520–521, 524 

Semilunar cusp, 97, 100 

Semilunar line, 134 

Semimembranosus, 300, 305, 307, 313–314, 316, 

340 

Semimembranosus bursa, 326 

Semimembranosus tendon, 313, 320 

Seminal colliculus, 235–236 

Seminal vesicle, 234, 236–237, 240 

imaging, 236 


Seminiferous tubule, 239 

Semispinalis capitis, 9, 39–40, 43 

Semispinalis cervicis, 43 

Semispinalis thoracis, 41 

Semitendinosus, 9, 300–301, 307, 313–314, 316, 

340 

Semitendinosus tendon, 313 

Septal cartilage, 566–567 

Septomarginal trabecula, 97, 105 

Septum pellucidum, 495 


INDEX 

1 

Serous pericardium, 93 

visceral layer of, 124 

Serratus anterior, 8, 38–39, 52, 70–71, 138, 396, 

398 


Serratus posterior inferior, 39, 71 

Serratus posterior superior, 39, 71 

Sesamoids, 331–332, 359, 428 

Shoulder 

bones, 386 


vessels and nerves, 400 

Shoulder joint, 7, 385–386 

Sigmoid arteries, 157, 170 

Sigmoid colon, 147, 157, 166, 222, 224, 230 


in transverse plane, 3 

Sigmoid sinus, 493 

Sigmoid vein, 181 

Sinu-atrial node, 105 

SI vertebra, body of, 219 

Skeleton 

anterior view of, 6 

cardiac, 100 

posterior view of, 7 

Skull 

anterior view, 478–479 

arteries, 492 

bones, 477 

cavity, 485 

imaging, 479, 481 

inferior view, 484 

lateral view, 480–481 

muscle attachments, 488–489 


roof, 483 


venous sinuses, 493 

Small intestine, 152–153, 164 


lymph nodes in, 12 


S1 nerve, 53 

S3 nerve, 53 

Soft palate, 552–553, 568, 581 

Soleal line, 293 

Soleus, 8–9, 341, 343–344 

Somatic afferents, 127 

Somatic sensory fiber, 127 

Spermatic cord, 138–139, 147–148, 234 


Spermatic fascia 

external, 149, 238 

internal, 149 

Spheno-ethmoidal recess, 568 

Sphenoidal sinus, 498, 552, 566–568 

Sphenoid bone, 477, 484–485, 527, 534, 572 

Sphenomandibular ligament, 528–529 

Sphenopalatine artery, 533, 535, 569 

Sphenopalatine foramen, 534, 567, 569 

Sphenopalatine vein, 533, 569 

Sphenoparietal sinus, 493 

Sphenoparietal suture, 480 

Sphenosquamous suture, 480 

Sphincter pupillae, 516 

Sphincter urethrovaginalis, 233, 259 

Spinal artery 

anterior, 46, 49, 502 

posterior, 46, 49, 499, 502 

left, 46 

right, 46 

segmental, 46 

Spinal cord, 23, 26, 32, 45 

cervical enlargement of, 45, 50 

Spinal cord (Continued) 

in cranium, 498 

features of, 45 

imaging of, 50–51 

lumbosacral enlargement of, 45 

segmental supply of, 46 



Spinal ganglion, 127 

Spinalis, 40 

Spinalis cervicis, 43 

Spinalis thoracis, 40 

Spinal joints and ligaments, 35–36 

Spinal nerves, 34, 44–45, 76 

anterior rami of, 252 

meningeal branches, 49 

Spinal vein 

anterior, 47 

posterior, 47 

Spiral ganglion, 524 

Spiral ligament, 524 

Spiral organ, 524 

Spiral valve, 178 

Splanchnic nerve(s), 114, 200 

greater, 116, 119, 185, 199–201 

least, 119, 199–200, 274 

lesser, 119, 185, 199–200, 274 

lumbar, 199–201, 274 

pelvic, 199–201, 252–254, 272, 274 

sacral, 200–201, 253–254, 274 

thoracic, 200 

Spleen, 153, 157, 160, 186 

in abdominal cavity, 159 

arteries of, 160–161 


hilum of, 159 

imaging of, 159 

location of, 159 


surfaces of, 159 

Splenic artery, 10, 157, 159–160, 179 

Splenic vein, 11, 159, 179–181 

Splenic vessels, 179 

Splenius capitis, 9, 36–40, 43, 71, 540 

Splenius cervicis, 9, 39–40, 71 

Splenorenal ligament, 159 

Squamous suture, 480 

Stapedius muscle nerve, 522 

Stapedius tendon, 522 

Stapes, 521–522 

Sternal angle, 62 

Sternal notch, 4 

Sternoclavicular joint, 62, 386, 388 

Sternocleidomastoid, 4, 8–9, 43, 504, 538, 540–541 

Sternocostal joint, 64, 66–67 

Sternocostal ligaments, 67 

Sternohyoid, 540–541 

Sternothyroid, 541 

Sternum, 64 


body of, 6, 62, 72 

manubrium of, 3, 6, 62, 64, 72, 386, 538 

Stomach, 152, 160, 186 

arteries of, 160–161 




external features, 158 

fundus of, 169 

imaging, 158 

internal features, 158 



Straight sinus, 493 

Striate artery, middle, 500 

Styloglossus, 529, 554, 579 

Stylohyoid, 540–541 

Stylohyoid ligament, 537, 554–555, 578 

Styloid process, 480, 484, 523, 527, 529, 540, 

554–555 

radial, 425 

Stylomandibular ligament, 528–529 

Stylomastoid foramen, 484, 522 

Stylopharyngeus, 554–555, 578, 581 

Subarachnoid space, 48 

Subclavian artery, 46, 70, 402, 546 

left, 10, 74, 83, 88, 101, 109–110, 113, 500, 

548–549, 564 


right, 10, 74, 82, 88, 101, 109–110, 395, 500, 

548, 564–565 

Subclavian groove, 388 

Subclavian nerve, 403 

Subclavian trunk, 77, 551 

Subclavian vein, 411 

left, 11, 75, 101, 110, 539, 557 

right, 11–12, 77, 82, 101, 109–110, 565 

Subclavicular nodes, 550 

Subclavius, 70–71, 116, 395 

Subcostal artery, 143, 192 

Subcostal muscles, 72 

Subcostal nerve, T12, 76, 144 

anterior cutaneous branch of, 125, 145 


Subcostal plane, 135 

Subcostal vein, left, 75 

Subepicardial fat, 93 

Sublingual caruncle, 582 

Sublingual fold, 582 

Sublingual gland, 532, 578, 580, 582 

Sublingular fossa, 572 

Submandibular duct, 578, 580, 582 

Submandibular fossa, 572 

Submandibular ganglion, 532, 579 

Submandibular gland, 532 

Submandibular nodes, 12, 506, 550–551, 580 

Submental nodes, 506, 550–551 

Submental vein, 539 

Subparotid node, 550 

Subphrenic recess, 154 

Subpopliteal recess, 326 


female, 214 

male, 212 

Subscapular artery, 401–402, 410 

Subscapular fossa, 387 

Subscapularis, 52, 398–399 

Subscapular nerve, 403, 405 

Subscapular nodes, 415 

Subtalar joint, 333 

Subtendinous bursa, 326 

Sulcus terminalis, 94–95 

Superciliary notch, 478 

Superficial temporal artery, 10 

Superior, as anatomical direction, 2 

Superolateral nodes, 365 

Superomedial nodes, 365 

Supinator, 8–9, 424, 432, 436 

Supinator crest, 406 

Supraclavicular nerve(s), 418, 542, 544–545 


lateral, 125 

medial, 125 

Supracondylar line 

lateral, 304 

medial, 304 

Supracondylar ridge, 406 

Supraduodenal artery, 157, 160, 163, 179 

623 


INDEX 

Supraglenoid tubercle, 387 

Supramandibular triangle, 536 

Supramarginal gyrus, 494 

Supramastoid crest of temporal bone, 526 

Supra-orbital artery, 506, 510, 515 

Supra-orbital foramen, 480 

Supra-orbital nerve, 503, 510–511, 513, 535 

Supra-orbital notch, 478, 508 

Supra-orbital vein, 506, 510, 515 

Suprapatellar bursa, 326 

Suprapatellar fat, 326 

Suprarenal artery 

inferior 

left, 190 

right, 190, 192 

middle, 184 

left, 190 

right, 192 

superior 

left, 190, 192 

right, 190, 192 

Suprarenal gland, 160 

left, 184, 186, 190, 193 

right, 184, 186, 190, 192 

Suprarenal impression, on liver, 173 

Suprarenal vein(s) 

left, 190, 193 

right, 190, 193 

Suprascapular artery, 400, 402, 414, 546, 548–549, 

564–565 

Suprascapularis, 395 

Suprascapular nerve, 400, 403 

Suprascapular notch, 386–387 

Supraspinatus muscle, 9, 38–39, 395, 398 

Supraspinous fossa, 386–387 

Supraspinous ligament, 35, 218 

Suprasternal space, 538 

Supratrochlear artery, 506, 510, 515 

Supratrochlear nerve, 503, 510, 513 

Supratrochlear nodes, 415, 457 

Supratrochlear vein, 506, 510, 515 

Sural arteries, 314, 342 

Sural nerve, 13, 315, 342, 347 


of abdomen, 134 

of arm, 408, 412, 431, 435 

of back, 20, 36 

of body 



of ears, 520 

of face, 508 

of foot, 353 

of gluteal region, 300 

of hand, 443, 452 

of head, 476 

of knee, 327 

of larynx, 558, 563 

of lower limbs, 292 

of mediastinum, 91 

of neck, 476, 536 

of pelvis and perineum 

female, 214–215, 256–257 

male, 212–213, 255, 257 

of superior mediastinum, 108 

of thorax, 62 

of upper limbs, 384 


of clitoris, 262 

of eye, 509 

of ovary, 224, 242 

of penis, 68, 222, 240, 260 

Sustentaculum tali, 330–331, 336 

Sutural bone, 482 

624 

Sympathetic cardiac nerves, 126 

Sympathetic ganglia, 32, 199 

cervical, 126, 403 

fifth thoracic, 88 

third thoracic, 107 

Sympathetic nerves, 14 

Sympathetic trunk, 78, 119, 544–545 

left, 107, 254 

left lumbar, 253 

right, 88, 107, 254 


in lower limbs, 297–298 

in upper limbs, 390, 422 

Synovial sheaths, in hand, 444 

T 

Taenia, free, 168 

Taenia coli, 164, 166 

Talocalcaneal ligament, 336–337, 352 

Talocalcaneonavicular joint, 333 

Talofibular ligament, 336–337 

anterior, 352 

Talonavicular ligament, 336, 352 

Talus, 6, 330–332, 334 

Tarsal artery 

lateral, 346 

medial, 346 

Tarsal bones, 6 

Tarsal gland, 509 

Tarsal muscle, superior, 509 

Tarsal sinus, 331 

Tarsal tunnel, 363 

Tarsometatarsal joints, 333 

Tarsometatarsal ligaments, 352 

Tarsus 

inferior, 509–510, 512 

superior, 509–510 

Tectorial membrane, 524 

Teeth, 573 

anatomy, 575 

crown of, 575 



nerves, 576–577 

root of, 575 


Tegmen tympani, 485, 523 

Temporal artery 

deep, 533 

middle, 533 

superficial, 500, 506–507, 510, 533, 546, 576 

Temporal bone(s), 477, 480, 485, 527, 572 

mastoid process of, 43 

Temporal fossae, 526, 528–529 

arteries, 533 

nerves, 532 

veins, 533 

Temporal gyri, 494 

Temporalis, 8, 504, 526, 528 

Temporal line 

inferior, 526 

superior, 526 

Temporal lobe, 495 

Temporal nerves, deep, 531–532 

Temporal sulcus, superior, 494 

Temporal vein 

deep, 533 

superficial, 11, 506–507, 510, 533, 539, 557, 576 

Temporomandibular joint, 528–530 

Tendinous arch, of levator ani, 227–228, 231 

Tendinous intersection, 140 

Tensor fasciae latae, 8, 292, 300–302, 305–307, 

316 

Tensor tympani muscle, 522 

Tensor tympani tendon, 521, 523 

Tensor veli palatini, 528–529, 554, 581 

Tentorium cerebelli, 492, 498 

Teres major, 9, 37–39, 52, 398–399, 412–413 

Teres minor, 9, 38–39, 398–399, 412 

Testes, 20, 147, 239 

appendix of, 238 

lobules of, 238 

Testicular artery, 10, 148, 162, 238–239 

right, 147, 192 

Testicular plexus, 199 

Testicular vein(s), 11, 148, 162, 193 

Thalamus, 495, 499 

Thenar eminence, 384, 443, 446 

Thenar muscles, 8, 434, 440 

Thigh 

arteries, 311–312, 314 

bones of, 293 

compartments of, 306–307 

deep artery of, 299, 312, 316 

deep vein of, 11, 316 

lateral cutaneous nerve of, 196–197 

muscle attachments, 305, 308–309, 313 

musculature, 306–309, 313 

nerves, 311, 314 

transverse section, 316–317 

Thoracic aorta, 10, 74, 82, 88–89, 101, 107 

Thoracic aperture 

inferior, 63 

superior, 63 

Thoracic artery 

internal, 10, 69, 74, 92, 143, 546, 548–549 

mammary branches of, 69 

lateral, 69–70, 401–402, 410 

superior, 401–402, 410 

Thoracic cavity, 79 

left, 116–117 

right, 114–115 

Thoracic curvature, 21 

Thoracic duct, 12, 77, 124, 185, 551 

Thoracic ganglia, 200 

Thoracic meninges, 48–49 

Thoracic nerves, 44, 395, 403, 545 

Thoracic vein(s) 

internal, 75, 109 

lateral, 142 

Thoracic vertebrae, 21–22, 26–27, 74 

Thoracic visceral plexus, 14 

Thoracic wall, 72 

anterior, 71 

arteries of, 74 

lateral, 71 

lymphatics of, 77 

posterior, 71 

veins, 75 

Thoraco-acromial artery, 70, 401, 410 

acromial branch, 395, 402 

clavicular branch, 395, 402 

deltoid branch, 395, 402 

pectoral branch of, 69, 402 

Thoracodorsal artery, 401–402 

Thoracodorsal nerve, 405 

Thoracoepigastric vein, 142 

Thoracolumbar fascia, 37, 39, 42 

Thorax 

bony framework of, 63–64 

dermatomes and cutaneous nerves of, 125 



Thymus gland, 12, 108 

Thyro-arytenoid, 561 

Thyrocervical trunk, 546, 548–549, 564 

Thyro-epiglottic, 561 


INDEX 

1 

Thyro-epiglottic ligament, 559 

Thyrohyoid, 540–541 

Thyrohyoid ligament, 558, 561 

Thyrohyoid membrane, 554, 558, 560–561, 563 

Thyroid artery 

inferior, 546, 548–549, 564–565 

superior, 500, 546, 564–565 

Thyroid cartilage, 552, 554, 558–559, 561, 563 

inferior horn of, 86 

left lamina of, 86 

superior horn of, 86 

Thyroid gland, 551–552, 563 

isthmus of, 563 

left lobe, 563, 565 

right lobe, 563 


Thyroid notch, 536, 558, 563 

superior, 86 

Thyroid prominence, 536, 558, 563 

Thyroid tubercle, 558 

Thyroid vein(s) 


middle, 564 

superior, 564 

Tibia, 4, 6–7, 292, 329 


Tibial artery 

anterior, 10, 311–312, 314–315, 327, 342, 346, 

354–355 

posterior, 10, 311–312, 327, 342, 355, 362 

Tibial collateral ligament, 308, 320 

Tibialis anterior, 8, 300, 343–345 

Tibialis anterior tendon, 351 

Tibialis posterior, 341 

Tibialis posterior tendon, 351–352 

Tibial nerve, 13, 314–315, 342, 361–362 

Tibial recurrent artery, anterior, 312 

Tibial tuberosity, 4, 6, 292, 304 

Tibial vein 

anterior, 11 

posterior, 11 

Tibiofibular joint, 318 

Tibiofibular ligament, 336–337 

T10 nerve, 144 

T12 nerve, 76, 144 


Tongue, 532, 552, 579 


arteries, 579 


inferior surface, 582 

root of, 553, 555 

veins, 579 

Tonsils, 12, 552–553, 568, 580–582 

Torus levatorius, 552 

Torus tubularis, 552–553, 568 

Trabecula, 12 

Trabeculae carneae, 97, 99 

Trachea, 79, 88, 110, 552–553 


bifurcation of, 113 


in superior mediastinum, 112 

Tracheal bifurcation, 86 

Tracheal cartilages, 86 

Tracheal mucosa, 86 

Tracheal nodes, 12, 77 

Tracheobronchial nodes, 114 

Tragus, 520 

Transversalis fascia, 42, 136–137, 140–142, 

148 

Transverse colon, 153, 157, 163 



Transverse fasciculi, 356 

Transverse plane, 2 

Transverse ridges, of sacrum, 294 

Transverse sinus, 493 

Transversospinales muscles, 41–42 

Transversus abdominis, 8, 40, 42, 136–137, 141– 

142, 148, 183 

aponeurosis of, 137, 139 

Transversus thoracis muscles, 72 

Trapezium, 426, 428, 440 

Trapezius, 5, 8–9, 36–37, 394–395, 408, 412, 

504 

Trapezoid, 426, 428, 440 

Trapezoid line, 388 

Triangle, lumbar, 37 

Triangle of auscultation, 36–37 

Triangular interval, 399, 414 

Triangular ligament, right, 172–173 

Triceps brachii, 9, 394, 398–399, 408, 412–413, 

431–432, 435 

Tricuspid valve, 96–97, 100–101 


Trigeminal ganglion, 498–499, 535 

Trigeminal impression, 485 

Trigeminal nerve, 13, 498–499, 511, 517, 532, 535, 

584 

cutaneous distribution, 503 

mandibular division, 531 

Trigone, 230, 232–233, 235, 240 

Triquetrum, 426, 428, 440 

Triticeal cartilage, 558 

Trochanter 

greater, 6–7, 226, 292–293, 295–296, 298–299, 

301, 308 

lesser, 6–7, 226, 293, 295–296, 298–299, 301 

Trochanteric fossa, 296 

Trochlea, 6, 406, 512 

Trochlear nerve, 498–499, 513, 584 

Trochlear notch, 406 

True ribs, 64 

Tuberculum sellae, 485, 534 

Tunica albuginea, 239–240, 242 

Tunica vaginalis, 234, 238–239 

parietal layer of, 149 

visceral layer of, 149 

TI vertebra, 21, 26, 63, 537 


TII vertebra, 64 

TIII vertebra, 26–27 

TV vertebra, 22 

TIX vertebra, 26 

TXII vertebra, 21, 26–27, 63–64 

spinous process of, 5, 20, 63 

Tympanic membrane, 521, 524 

Tympanic nerve, 522 

Tympanic plate, 527 

Tympanic plexus, 522, 532 

Tympanomastoid fissure, 527 

U 

Ulna, 6–7, 385, 425 


tuberosity of, 420 

Ulnar artery, 10, 410, 424, 434, 437 

Ulnar collateral artery, 401–402, 410, 414, 437 

Ulnar collateral ligament, 429 

Ulnar collateral vein, 411 

Ulnar nerve, 13, 395, 403–405, 410, 424, 434, 437, 

451 

Ulnar notch, 425 

Ulnar recurrent artery, 410, 414, 434, 437 

Ulnar vein, 11 

Ulnocarpal ligament, 429 

Umbilical artery, 246, 248, 251 

Umbilical fold 

lateral, 149 

left, 151 

left bilateral, 141 

medial, right, 151 

median, 151 

Umbilical ligament 

medial, 149 

median, 141, 149 

right, 141 

Umbilical region, 135 

Umbilicus, 4, 134 

Umbo, 521 

Uncinate process, 24, 176, 567 

Uncovertebral joint, 24 

Uncus, 494–495 

Urachus, 222, 224, 230, 232 

Ureter(s), 224 

left, 147, 160, 162, 184, 232–233, 237 


right, 160, 232–233, 237 



visceral sensory diagram, 204–205 

Ureteric orifice, 230, 232–233, 235 

Urethra, 236 

female, 224, 233 

membranous, 222, 235 

penile, 236 

prostatic, 222, 232, 235 


spongy, 222, 234, 240 

Urethral orifice, external, 20 

female, 256 

male, 240, 257 

Urethral sphincter 

external, 20, 224, 230, 232–233, 235–236, 

259 

internal, 230 

Urogenital hiatus, 227–229, 258 

Urogenital triangle, 255 

Uterine artery, 248–249 

Uterine tube, 147, 224, 241–242 

ampulla of, 242 

folds of, 242 

infundibulum of, 242 

isthmus of, 242 

Uterine vein, 248–249 

Uterosacral ligament, 224, 243, 245 

Uterus, 147, 242–243 


external os, 224, 241 

fundus of, 242–243 

imaging, 244 


internal os, 242 

round ligament of, 146–147, 224, 

241–243 




Utricle 

auricular, 524 

prostatic, 235 

Utriculosaccular duct, 524 

Uvula, 552–553, 555, 581 

V 

Vagal ganglion, inferior, 127, 562 

Vagal trunk, 118 

anterior, 199–201 

posterior, 199–201 

625 


INDEX 

Vagina, 224 

fornix, posterior, 224 

posterior fornix, 241 


Vaginal artery, 246, 248–249 

Vaginal orifice, 224, 233, 256 

Vaginal wall, 242 

Vagus nerve, 585 

cardiac branches of, 110 

carotid body branch, 543 

in cranium, 498–499 

dorsal motor nucleus, 126 

inferior ganglion of, 556 

left, 88, 107, 110, 118, 201, 562 

parasympathetic cardiac branches, 126 

pharyngeal branch, 543 

in pharynx, 556 

right, 88, 107, 110, 118, 201, 562 

thoracic cardiac branch of, 107 

Vallate papilla, 555, 580 

Vallecula, 552, 580 

Valve(s) 

aortic, 100–101 


of foramen ovale, 98 

heart, 101 

of inferior vena cava, 96 

of lymph node, 12 

mitral, 98–99, 101 


pulmonary, 97, 101 

tricuspid, 97 


Vasa recta, 165, 170 

Vasculature. See Arteries; Vein(s) 

Vastus intermedius, 305, 308, 316 

Vastus lateralis, 8, 292, 300–301, 305–308, 316, 

327, 340, 343–344 

Vastus medialis, 8, 292, 305–306, 308, 316, 327, 

344 

Vein(s). See also individual veins 

arm, 411, 457 

eyes, 515 

facial, 506 

hands, 457 


leg, 364 


neck, 539 

parotid region, 507 

pelvic, 247 

pharynx, 556 

of prostate and penis, 250 

Vein(s) (Continued) 

rectal, 251 

teeth, 576 

temporal fossae, 533 


thyroid gland, 564 

tongue, 579 

Vena cava 

inferior, 11, 75, 82, 94, 96–99, 101, 160, 186, 193 

abdominal, imaging, 194 

imaging, 194 

valve of, 96 

superior, 11, 63, 74, 82, 89, 94–99, 101, 564 

Venous arch, dorsal, 292, 364 

Venous plexus, rectal 

external, 231 

internal, 231 

Venous sinuses, dural, 493 

Ventricle 

left, 63, 93–95, 98–99, 101 

right, 74, 94, 96, 97, 103, 105 

Vertebra(e). See also individual vertebrae 

cervical, 21–25 

lumbar, 21–22, 27–30 

regional, 22 

thoracic, 21–22, 26–27, 74 

Vertebral artery, 10, 43, 46, 402, 499–500, 546, 

548–549 

left, 500 

right, 500 

Vertebral canal, 33 

Vertebral column, 7 


cervical, 50 



splanchnic nerves and, 200 

upper thoracic, 50 

Vertebral foramen, 22 

Vertebral plexus, anterior 

external, 47 

internal, 47 

Vertebral spinous process, 20 

Vertebra prominens, 5, 20, 23 

Vertical axis, 2 

Vesical artery 



Vesical fascia, 230, 232 

Vesical plexus, 247, 250 

Vesical vein 

inferior, 247–248, 251 

superior, 245, 247–248, 251 

Vesico-uterine pouch, 224, 245 

Vesicular appendix, 243 

Vestibular, as anatomical direction, 573 

Vestibular aqueduct, 524 

Vestibular fold, 560 

Vestibular gland, greater, 241, 262 

opening of duct, 257 

Vestibular ligament, 559 

Vestibular nerve, 520–521, 524 

Vestibule, 524 

Vestibulocochlear nerve, 498–499, 520–521, 524, 

585 

Visceral pleura, 79, 124 

Vitreous chamber, 516 

Vocal fold, 552, 560 

Vocalis, 561 

Vocal ligament, 559, 561 

Vocal process of arytenoid, 559, 561 

Vomer, 477, 484, 486, 566–567, 572 

Vorticose veins, 515 

W 

White ramus communicans, 78, 126 

Wrist crease, 443 

Wrist joint, 7, 385, 425–427 

X 

Xiphisternal joint, 64, 67 

Xiphoid process, 4, 6, 62–64, 134 

Z 

Zona orbicularis, 298–299 

Zonular fibers, 516 

Zygapophyseal joint, 24, 28–29, 218–219 

capsule of, 35 

Zygomatic arch, 526–527 

Zygomatic bone, 6, 477, 480, 483, 508, 527, 534 

Zygomatic nerve, 535 

Zygomaticofacial artery, 506 

Zygomaticofacial bone, 480 

Zygomaticofacial nerve, 503, 531, 535 

Zygomaticofacial vein, 506 

Zygomaticotemporal artery, 506 

Zygomaticotemporal nerves, 503, 511, 531, 535 

Zygomaticotemporal vein, 506 

Zygomatic process of frontal bone, 478, 526 

Zygomatic process of maxilla, 478 

Zygomatic process of temporal bone, 480 

Zygomaticus major, 504–505 

Zygomaticus minor, 504–505 

626

GRAY's Atlas of Anatomy

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